The Rest of the Story
You may recall from the book that I described in detail two years of intense job stress and pressure prior to my heart attack in 1999. Even the terms "heart attack" seem too strong for that experience. I had some slight heaviness in the chest and left arm - but unlike anything I had experienced. I took two aspirin and told Rick we should probably head in to the ER. The enzymes did not show the heart attack at first, but the doc said stay overnight for observation. The next day, the blood test indicated a heart attack. So it was an ambulance ride 90 miles south to Duluth, with the nitro and heparin IVs in place.
An angiogram, 2 stents, and 2 days later, I was home and ready to go back to work. No big deal. I didn't even quit smoking.
Did the two years of job stress cause the heart attack? Who knows, but I was always reluctant to draw that conclusion because CAD (coronary artery disease) runs in the family. My younger brother (3 years my junior) had 5 bypasses over 20 years ago. In any event, 2 quick stents had me all fixed up, no muss, no fuss. I never worried or fretted about it, never looked back.
Well, 10 years later in April 2009, it was time to look back. Plaintiff Blues, the book, was selling well. We were in a 3rd printing, all the bills were paid, the book had won 5 national awards, and the speaking/signing schedule was filling fast. We always knew that we would have to do all the work of marketing and selling the book. We were pushing hard, the big "mo" was on our side.
Five AM Tuesday, April 8 was the third day in two weeks that a nagging ache in my chest on the left side woke me up. Again I took 2 -3 nitro, but this time I didn't go back to sleep. I had nothing scheduled the next day or two, so it seemed like a good time to go in and get it checked. I waited until the clinic opened and called in for an appointment. However, just the mention of chest pain results in immediate directions to the ER. I figured it would again be a stent or 2, a day or 2, and we'd be back in business. Relatively speaking, no big deal. Or so I thought.
The doctor on call was not one of our local doctors. He was what we call a rent-a-doc. He had worked in Cook before, but it still seemed that everything took extra time. By the time the EKG results and the blood tests were back, it was almost noon. He consulted the cardiac specialists in Duluth with the results and the decision was to get me down there for an angiogram. No surprise with that, but I was a bit concerned when he gave us the choice of the life-flight helicopter or ambulance. I chose the ambulance, but we had to wait for the Virginia ambulance to get up to Cook. The Cook ambulance was out on a run.
It was after 4 pm when I got down to Duluth. We knew the test wouldn't be run until the next day, so Rick stayed home and came down first thing the next day. Our chocolate lab Java was sick and needed meds twice a day, so best for Rick to take care of that before he came down to Duluth. As it turned out, I didn't get into a room at St. Mary's Hospital until well after the super hour. I remember that because I was starved. I hadn't eaten anything all day. A very helpful nurse found the last egg salad sandwich in the refrigerator. That was the best egg salad sandwich. Just in time too, because it was no food or drink the night before the angiogram.
I was scheduled for the angiogram/cath lab first thing the next day. Rick got in before 8 am, which means he had to leave home before 6 am. They got backed up for some reason and it was after noon before they came to get me for the test. I was a bit frustrated because all the delays and waiting would now cost us an extra day at least.
During this angiogram, I must have dozed off or been more heavily sedated because I do not remember any of the process - like I did with the stents back in 1999. When I came to, Rick was there and we were led into an office with several doctors. I was curious about how many stents this time, but they said no stents. The cardiologist explained that there was so much blockage, they would have to do open-heart, by-pass surgery. He introduced the surgeons in the room who explained the procedure. I wasn't paying a lot of attention, still dopey from the angiogram - and a bit shocked.
The head surgeon explained that there were 8 or 9 blockages that had to get repaired. I asked how many they could do at one time and he said he had done 8 once. I jokingly said, "Well, let's go for a record of 9." What else do you do when you get information like that? It's a little bit about lemons and lemonade I guess. I asked when they would schedule this monumental procedure, figuring I could put it off for some time and get things ready - myself included.
When we got back to the room, we decided Rick should head home - it a 2 hour drive and it was already past supper time. He needed to make arrangements, call the boys and the family. We had originally thought we could get by without alarming the kids, just filling them in after we got home with the stents, like we did the first time. That was no longer the case. After we finished comparing notes and lists, Rick took off for home and I went in search of another egg salad sandwich. I had to settle for peanut butter, but it was better than nothing and once again, food and drink were cut off in preparation for surgery.
There was a computer set up at the lounge area at the end of the hallway and I took the opportunity to check the calendar and email contacts regarding upcoming speaking/book signing events. I had asked the docs if I could make it to the events in mid-April. They said no way and suggested canceling the entire month! That should have been a clue.
Back in my room, a friendly pastor stopped in to see if I needed anything. He asked if I had done a health directive. Rick and I had talked about it a couple of times, but like most folks, never got around to it. I told him we had trouble finding the words to express our wishes and didn't know what to put on the dos and don'ts lists. He said he had some examples of language others had found useful and asked if I would I like to look them over. There was literally no time like the present!
I found language that worked for me, filled out the form and he got it notarized that evening. It did give me a sense of relief, but I was still having trouble falling asleep - thinking of all the things I should have done, arrangements, etc.
Both Rick and Erik were there first thing the next morning and waited with me until they took me in for surgery. I was sure glad Erik had gotten there so Rick had someone to wait with him. I know they were going to have a long wait and I warned them to be prepared for a shocker when I came out. I had been there with my folks. There would be more tubes, pumps, and machines than they could imagine. Max was flying in later that morning. We were lucky because he was still on a short-term project in Texas and not at his base assignment in Korea.
The next couple of days are mostly a blur. Apparently the surgery went well into the afternoon - about 7 hours on the heart-lung machine. (It still blows my mind to think that my heart was out of my body for that long!) I'm sure glad Rick had the kids there for that long wait. In the next days, Erik and Max stayed down in Duluth, but Rick drove back and forth everyday to take care of the dog. I was pretty doped up - thankfully because unlike everything else, the pain was very memorable.
That first day was especially rough with the ventilator tube down my throat. Apparently I had some respiratory trouble after they took it out, coded they tell me. I came to with a huge mask on my entire face. When I tried to lift it off to talk, the nurse hollered over the rushing air to leave it alone or they would have to put the ventilator back in. I heard that loud and clear - and shut the hell up.
I think one of the times I coded was right after they pulled the drain tubes out of my chest. That was huge pain that seemed to pull the guts right out of me! I could see that Rick, the kids and families were really worried with everyone scrambling. I knew I looked like hell and I felt terrible to be worrying them, but I couldn't talk through the mask to reassure them.
I learned to tell time in 4 hour blocks. That was the amount of time between pain meds - which only lasted about 2 - 2 1/2 hours. The first few days the nurses were absolute saints. They seemed to know when the pain crept in and would find a little bump to get through that last hour. And I soon learned to hold off if necessary to time the end of the 4 hour med cycle around the shift change. After the first couple of days, I did not have a nurse by my side at all times. I could wait an hour or more for the meds if I didn't time it right going into the shift change.
Fortunately, after a couple of days the crises passed and the mask came off. Erik had to go home after that weekend, but Max stayed until Tuesday. He'd spend the end of each day with me, after Rick had taken off to go home.
The nurses the first 2-3 days were great. However, that did not apply to the night shift. There was a nurse on the night shift - my last two nights in cardiac intensive care - who still gives me nightmares! She's part of the reason for adding this last chapter to the story. Writing the book was cathartic for the plaintiff blues, so hopefully this will take care of my Nurse Ratched nightmares.
Even her appearance set her apart from the others. They had all been in scrubs. This gal was decked out in an outfit that included an attractive print jacket and color-coordinated slacks to match. Her hair looked professionally coiffed and she had plenty of perfectly applied makeup. She introduced herself, asked me a couple of questions, then proceeded to talk through my answers. She never answered my questions. The other nurses made me feel like I was the center of their attention. She made me feel like I was just another item on her check-list.
One of the procedures that the nurses performed was to roll me sideways to change sheets. Suffice it to say it hurt like hell. The nurses had been great about waiting until the pain meds had taken hold. Not this gal. It was about 3 am and I asked - begged, actually - for her to wait 15 minutes or so until I could get the next round of pain meds. No way, her schedule mattered more than I did. I laid awake the rest of that long, long morning. Pain was part of it, but mostly it was frustration and helplessness. You are so utterly helpless, pinned by pain and tubes - can't even sit up by yourself! She actually made me cry - and that's something.
It was too bad that Erik and Max could not stay until I got out of the intensive care unit. Recovery seemed to go pretty fast, although I still had the IV, catheter, and drains in my legs where they had stripped veins for the heart grafts. The doc said they did 7 grafts in all, catching a couple blockages 2 for 1. As the discomfort in my chest receded, my legs started to bug me more - and that has continued to today! The surgeon had told me to walk as much as I could - the more I walked, the sooner I'd get out of there.
At first, I was not supposed to walk unless someone was with me. Between my IV tree, the catheter bag and the walker, I was a parade all by myself going down the hall. Soon, I was able to go on my own and I walked several times each day. Now I was chomping at the bit to get out of there. It was eleven days since I went in. When I asked, the cardiologist said the "diabetic specialist" would be in for some training and then I could head home. I looked at Rick - and we quickly told him I was not diabetic and never had been.
Surprise! Apparently the prednisone they were giving me requires a weaning process to stop - and during that process you become temporarily diabetic. I was shocked! That was the first we heard that I would have to check blood sugar and take insulin everyday! The total list of drugs and paraphernalia we had to get on the way home was enough to open a drug store!
Friday, April 17. I was happy - feeling sore but liberated - to get out of the hospital and head for home. Rick stopped to get us a Dairy Queen on the way out of town and it never tasted so good! When we got home, the first thing I did was make an egg salad sandwich. The egg salad was better, the bread was better, but it didn't taste as good as the one that first night in the hospital.
The first challenge at home was facing the fact that we did not have a hospital bed. Somehow we had to make our regular bed comfortable. It took 4-5 extra pillows (and some pain meds) before I could lay there and get to sleep. Getting in and out of bed was also a chore. But it got a little better each day. I had to do sponge baths for awhile and I still had a lingering battle with adhesive. It was all over my body it seemed, from holding tubes and drains and IV's in place.
On April 28, an x-ray and follow-up visit with the surgeon in Duluth was positive and I made the first trip to cardiac rehab the next day. Fortunately, I was able to do the rehab 7 miles from home at the Cook Hospital. I did the first - very light and easy - rehab session on Thursday, April 30.
The next night was a crisis. When I went to get into bed, I had terrific pain in my chest. I absolutely could not lay down the pain was so intense. I slept that night in the living room chair. I had to do the same the next couple of nights. No way I wanted to go into the hospital. Monday I went in for my scheduled rehab appointment and told the nurse about the pain. She listened to my heart and lungs and said it sounded like there was fluid in my lungs. Apparently another rehab patient had had the same problem and had to have lungs drained. That did not sound appealing to me at all. However, the pain continued and I was still sleeping in the chair. I called the cardiologist and got an appointment to see him that Friday (one week after the pain showed up). He said I'd have to see the surgeon to get the lungs drained - and made the arrangements for that Monday, May 11. More nights in the chair and then back to Duluth again.
To say the procedure to drain the lungs was unpleasant would be a significant understatement. They drained more than a liter from just one lung! The doctor said the other lung sounded better, and they'd let the diuretic lasix take care of reducing that remaining fluid. By the time I had another xray and got dressed, I was hurting big time. The docs gave me some pain meds for the ride home. I didn't tolerate the meds very well and had to stop twice to use the bucket. I had gotten used to carrying a bucket wherever I went.
It was another week - May 18 - before I could return to rehab and start again. Rehab went well and I was finally feeling better all the time. I continued in rehab through June and July. I was really pushing myself in those sessions. I figured if there was going to be a problem, I'd rather have it right there in the hospital. The only issue I had was a sort of clicking in my chest, not painful but very disconcerting. I had had it from the very beginning, even before starting rehab. It was getting more frequent and more bothersome.
I finished rehab in August and was feeling pretty good. I was able to really push the stats - pulse, blood pressure - and recover to normal in very short time. The clicking was still there, but not really painful and never interfered with rehab. Of course my legs were another issue altogether. There were 8 incisions (5 on one leg and 3 on the other) to harvest the veins for the heart repairs. As a consequence of the reduced circulation, my legs swelled everyday. So I was still taking hefty doses of lasix and potassium, to keep the fluid at a minimum. I was wearing compression socks everyday as well.
Rick and I joined Erik and Max and families in Hawaii for a reunion/vacation that December 2009. I did not wear my socks that week in that heat and humidity. I paid for that. It took a couple of weeks before I could get the swelling back to normal levels. And the chest clicking continued.
In February 2010, I made an appointment with the surgeon. After an xray and exam, he said all was normal and looked good. He thought the clicking would stop before long. He said sometimes it took 2 years for complete healing after open heart surgery. On Friday, March 19, I saw a new cardiologist for an annual checkup. She was concerned because my blood tests indicated higher than normal inflammation levels and ordered mega doses of ibuprofen. She also thought those meds might reduce the clicking. I'd see her again in two months.
Those med orders and plans were blown away the next day when I fell and broke my ankle. Rick and I were cutting dead trees and clearing brush from the woodlot. It was a beautiful and unusually warm spring. The snow was long gone. I tripped on a tree root and down I went - with a armful of branches so I couldn't catch myself. Broken bones were nothing new for me, but this was a particularly bad break and would require surgery to repair.
The surgery was scheduled for the following Friday, March 26, 6 days later. Those were a long 6 days with a hurting ankle, even though it was splinted. Once again, I was taking pain meds and carrying a bucket wherever I went. Surgery went well, but I was back in a cast and on crutches again. It seems that each time I used crutches was harder than the last time. Wonder if age has anything to do with it Maybe cracking the chest was a factor.
The plaster cast came off and I was in a boot cast. The crutches were easier and life was better. However, the incision was not healing well. By mid-may it was red, hot and oozing. So May 20, I had another surgery to debride and clean the wound. The surgeon also removed a couple of the screws. He said the bone was healed and looking good and strong. But once again, the would would not heal.
I had been doing some book signings and was scheduled to instruct another administrative course in the upcoming summer session. By the end of June, the ankle was getting worse. I cancelled the book signings and the teaching. By July 2, I was back in surgery. This time, the surgeon removed the rest of the hardware - plate and screws. We asked if they had cultured the infection to see what was causing the problem and we were assured that they had. I spent that night in the hospital with IV bags of antibiotic.
Stitches from the last surgery finally came out on July 26. Within a couple of days it was clear that the wound was still not going to heal. I started seeing wound specialists at the hospital rehab. They were treating it with a silver gauze. Rick was changing the dressing every other day. This went on for weeks. Two weeks into it, the rehab tech took out a stitch she found as she picked away at the infection. We were hopeful that was the cause. No such luck. Rehab folks recommended another surgeon who worked with them on wound care. He took out another stitch as he examined the wound.
By now, there was a hole in my ankle clear to the bone. Suffice it to say this was getting very depressing! I couldn't get on with my life. This second surgeon said we needed to have an MRI to look for infection in the bone itself, called osteomyelitis. So August 19, I had an MRI in the morning. Rick picked me up right after that and we flew to Alaska for our annual salmon trip. The results could wait until we got back!
We got back from Alaska late on August 29. There were two messages on the answering machine from my doctor to call for the results of the MRI. I called first thing the next morning. There was infection in the bone and I had an appointment with an infectious disease specialist in Duluth at 9:15 am the very next day. Certainly not wasting any time!
Rick and I were up early to make the 2 hour drive. The doctor looked at the MRI and examined the bone. He left to make some calls. He called the original surgeon to find out what the culture had revealed about the infection. When he came back to talk to us, he was very disappointed because somehow the culture taken had not been completed or followed through by the hospital lab after the last surgery. So now we're seeing the specialist who matches the drug to the bug, only we don't know which bug!
The consequences were that I'd have to do 6 weeks of IV antibiotics. I figured there was a way to do it at home - no such luck. I'd have to go into a hospital everyday for 6 weeks to get the infusion. I told him we would have to wait because we were going to Washington DC in two weeks to see Max and family, who had just settled in after 2 years in Korea. Cancel he said, you have no choice if you want to save the leg and/or avoid sepsis - which is life threatening. Very depressing. I had no idea how serious it was.
He sent us from the clinic over to the hospital day surgery to have a central line installed and to have the first infusion - which took about 2 hours itself. It was after 6:00 pm when we left for home. The good news was the doctor and staff had make all the arrangements for me to have the next 41 days of daily infusions at the Cook Hospital. The other good news was that after explaining the situation, the airline allowed us to change our tickets to Washington DC until after the 6 weeks of IV antibiotic.
Once again, Rick and I raised a glass with what was becoming an all too frequent toast, "It could be worse!"
The other good news was that the infectious disease doc had also given us an expensive iodine ointment to apply to the wound. Rick was still cleaning and dressing that $%#@! every other day - as he had been for 6 months. This time, however, he was seeing progress almost every time. The wound was actually getting smaller and appeared to be closing up. At the end of the 6 weeks of IV antibiotic (mid-October) the wound was healed! Was it the ointment or the antibiotic? What difference did it make, it was finally done.
I faithfully worked out 3-4 times a week all that winter. I was so glad and appreciative to have two working legs back - albeit, still swelling without my compression socks - but hey, no bandages or ointments. Life was good.
While I was feeling better and stronger all the time, Rick's hip was getting worse. He couldn't even ride the snow machine we bought to go ice-fishing. So, he saw the orthopedic surgeon in February and got a new hip in April. The doctor told him he probably had a year or two before the other hip needed to be replaced. Now it was my turn to help him - long overdue for all days and nights he helped me. Back to bandages and dressings, but this time, not mine.
Rick's recovery went very smooth, did not interfere with fishing at all. However, the amount of clicking and shifting I was experiencing in my chest seemed to be increasing. So I had another x-ray and meeting with the heart surgeon on July 7, 2011. He showed us where some of the wires used to hold my sternum together had pulled through one side. At least we knew what was causing the clicking. He said it could be repaired, but the description of the procedure was less than inviting. He also said it did not have to be repaired unless it was interfering with life activities.
The major problem I had and still have with this clicking/shifting chest is getting to sleep at night. It is difficult to change positions in bed or find one that is comfortable. It's while I'm waiting for sleep to overtake me every night that I get my visits from Nurse Ratched. But I will put up with a lot of clicking to not go back to the hospital or get cracked open again.
In November, I saw a new cardiologist for an annual checkup. She reviewed all the chest x-rays from the beginning and confirmed that I have a sternal non-union. We discussed how it could have happened, but there are no answers. She suggested it could have been the prednisone that I was given at the time of the open-heart surgery, which tends to prevent healing. It could have been all the time on crutches, although some clicking was there before I broke my ankle. Her only caution about living with the non-union was if I got hit by the air bag in a car accident. Apparently it causes quite a jolt to the chest and could be a problem for me?
I haven't quite figured out what I should do differently with that caution. Still working on it.