If the Doctor says 'You may feel a little discomfort`, you know it's going to hurt like Hell. There is no getting away from it. If someone came up to you in the street and sliced you from chin to naval and then prised your ribs open with stainless steel clamps and cut your heart about for a while, you are going to feel some discomfort.
The saving grace in heart surgery is that at least you are asleep when it happens. On the other hand, in the former scenario you don't have to spend 6-9 months lying awake at night trying to figure out how many times a 33-1 shot has been first past the post.
I can only speak from my own experience of heart surgery and I'm sure that others have had different experiences. When I was 9 years old our GP discovered that I had a heart murmur, this led to regular hospital check ups and penicillin every day until I was 17. At some point during one of these hospital check ups someone said that one day I may have to have an Aortic Valve replacement, but it was nothing to worry about as it had become quite routine, I think I was about 12 at the time. That was 30 years ago, and I had all but forgotten about it.
It was during a routine medical check for life insurance that it was discovered that all was not as it should be and I was referred to Birmingham's Queen Elizabeth Hospital last November for an angiogram. This is the start of 'discomfort', although thinking about it this was really more discomfort than searing pain. Admitted as a day patient I was taken on a trolley into theatre where a camera was inserted into a main artery in my groin, this in itself was OK as I was given a local anesthetic. It was the sensation of a tube traveling up your body and into your heart that was very disconcerting, and when it enters your heart, it stops. Both camera and heart. After a few flutters gets going again. This they don't tell you. Then comes the dye. 'You may feel a slight sensation of passing water' I was told. Too bloody late mate!
The whole procedure took about 20 minutes and then I was taken back to the ward, dignity still in tact, to lie quite still on my back for 2 hours. Some 6 hours later the Professor who had done the procedure came to tell me the results of his findings. ‘Well Mr Cotton it appears that we need to replace the valve in you heart and you will be referred to.........' a pat on the hand and he was gone to the next poor sod. That was it, a bit unsteady on my feet I arrived home and sank into the sofa and promptly bust into tears. Nobody told me that would happen.
A couple of months later I was sent an out patients appointment to see the surgeon who would carry out the operation. Even at this stage, although there was some apprehension, the actual operation didn't seem to be a reality. Having met the surgeon there was some sense of reassurance. He didn't seem very impressed that I had given up smoking some 3 months earlier or that I was trying to loose weight. However, he was a nice chap who said that there was a 3-4 % chance of something going wrong. Still if something does go wrong it's nice to know that the man holding the knife is a nice chap. Even I have heard of 25-1 outsiders coming in first with some regularity. I was offered the choice of a mechanical valve or a pigs valve. I had never thought about butchers all over the country selling body parts to hospitals. So on the surgeon’s recommendation; taking my age into account (41), we opted for a mechanical valve which would have a longer life before it needed to be replaced. Oh goody, I get to go through it all again when I'm in my sixties.
The only draw back to a mechanical valve was that I would have to take Warfarin for the rest of my life, rat poison. This was to keep the blood thin. Also I would have to adjust my drinking habits as alcohol also thins the blood. Oh I could go down to the pub and sink 8 pints, but I would have to do that every night so the medication could be adjusted accordingly. Not even I could manage that. So that was it, I would be placed on the waiting list and would be called in 6-9 months. All I had to do was wait and loose weight - not that easy for a comfort eater.
Even though the inevitable was looming I put it to the back of my mind in order to enjoy the summer holiday with my wife and kids. Sitting on the bank of the river in south west France watching the kids messing about in the water, you wonder if this would be the last holiday, then you shove back to the back of your mind again. It still seems far off. As the six month mark approaches you start to catch up with things at work, making sure that your personal affairs are up to date - just in case 'The Grim Reaper' comes in at 25-1. Once past the six month mark you take a deep breath before you pick up the mail lying by the front door, and breathe a sigh of relief when the brown envelope with the hospital logo is not there.
It was mid September when the letter arrived. There was no-one except me in the house, no-one to watch me curl up into a ball and sob like a baby. This is before I'd even opened the bloody thing. Having composed myself I opened the letter 'Operation provisionally booked for the week of the 29th with a pre-admission day on the 26th'. Today was the 24th. The next emotion that hits you, and hit you hard, is blind panic. Head racing, heart pounding, running around the house going absolutely nowhere. 5 days. Was that all I had left to live? It may be irrational, but it goes through your mind. Then anger sets in. Why me? What the F..... have I done to deserve this? The fact that the odds of everything being all right vastly outweigh the odds of things going wrong doesn't seem to enter the equation. Will the kids be OK?, can my wife cope without me? I thought I had got myself under control so I rang my boss to let him know, I couldn't get it out. The brain wasn't designed to handle so many emotions at the same time, least ways mine wasn't. I cried myself to sleep that night.
Thursday the 25th September - Still very emotional, still can only see one horse at the starting gate. Thinking about it , it's not the actual mechanics of dying that frightens me, chances are I wouldn't know anything about it. If anything I'm curious about it, though not curious enough to want to try it yet. No, what scares the crap out of me is not seeing the kids grow up, not being there for them. Leaving my wife to go it alone. That is without a doubt the most terrifying feeling anyone can have.
Friday and the whole family know now. Everyone is well meaning, ringing up to see how you are coping, which only makes you more tearful. Being very sympathetic, saying things like 'hope all goes well' and 'I'm sure it will be OK' and other well meaning phrases that infer that something could go wrong. In the end you put up a front and outwardly become quite indifferent about the whole thing. Then when no-ones around ball your eyes out. Anyway, this is Friday - pre-admission day, the day when you find out what it's all about. I took myself to the hospital, wishing someone was with me. I didn't want to be sat in waiting rooms all alone. The first thing that struck was how full the waiting room was. Good God, I'm not the only one to be having heart surgery, I'm not alone. Sure people had said that it happens all the time, but until that moment it didn't sink in. Small comfort, but some comfort. I didn't know that nearly 20,000 heart surgery operations take place every year in the UK, so they must have a pretty good idea of how to do it by now.
First off I see a doctor/houseman who makes sure I know what it all entails, not so much to comfort me as to make sure that when I sign the consent form he puts in front of me I know what I'm signing and won't sue the hospital when I come out with a chest wound thinking I went in for a vasectomy. Next I have an X-ray and an ECG. Then the admission nurse, who tells me that I am booked in for the following Monday to be operated on the Tuesday, but to phone in after 11am to make sure there's a bed for me. Great, I get 5 days notice to open heart surgery. Maybe. The next person to see is a ward nurse, perhaps the most useful in terms of making me feel at ease. She described what would happen during my stay at the hospital, from coming out of theatre into intensive care, then to high dependency unit, then onto the ward. She asked if I was anxious about it all. I said yes. She said some people take in their stride. I said some people are bloody liars. But for the first time I felt that there was someone who was willing and able to answer any questions I had, and genuinely wanted to help. The trouble was I couldn't think of anything to ask, I should have made a list prior to the visit. That night I got as drunk as a skunk. A few hours immortality.
I spent the weekend trying to avoid any mention of the operation, dreading the phone ringing in case it was someone asking how I was coping. I woke up on the Monday morning, the day of admission, with a sore throat. The kids had been unwell over the weekend and a friend who came to stay to help with things for a while came down with flu. I rang the hospital to inform them of my condition. They cancelled me for that week. Funny but my throat got better remarkably quickly. The relief was immense. The admissions nurse said that she would be writing to give me another date, in a couple of weeks. Now, was that to be admitted in a couple of weeks or would I get the letter .
It was the space that I needed to put everything into perspective. I had resigned myself to the fact that the operation must happen, and as the two week marker passed I found I was looking for the letter from the hospital. Still some concerns creeping in, wouldn't be human if there wasn't, but I must say that I felt much more confident about it all.
I was admitted on Monday the 20th of October, my boss took me in, which was my preference. I didn't know how I would cope if my wife took me, I'm sure she wanted to but somehow she seemed to know what I was thinking and I didn't have say anything. She was ahead of me all the way. There was a letter from my mother who lives in France waiting for me on the bed. I stuffed it in my bag, unopened.
I was in a five bedded ward, the other beds were taken up with people who had already had their operations be it valve or by-pass or both. Although a got a few comforting words and sympathetic smiles from them, they were more concerned with resting and trying not to cough.
I wondered why they all had small rolled up pillows by their sides. The evening was spent with intermittent visits from various hospital staff taking blood, weighting me, and talking about the operation. Again it was the nursing staff who seem to be there for you and willing to answer any question honestly and with compassion. I read for 3 hours before falling asleep around midnight, having read 3 pages.
I was woken at 6 am, given a chance to shower before donning the gown. What I would have given for a cup of tea. At 7.00 I was given a pre-med and at 7.30 I got a message from my wife wishing me luck. I wish she hadn't done that, up until then I was doing all right. Fighting back the fear, I lay back on the bed and allowed the pre-med to act. I have a vague memory of being wheeled down the corridor, but that was it until I woke when the deed was done.
My first recollection was of bright sunshine through a window, and my first thought was 'I made it!' For the 5 seconds or so that I was conscious I felt elated. My next awakening was not so good. I had a tube the size of a sewer pipe rammed down my throat. remembering what the nurse had told me the night before, I tried to relax and allow the ventilator do it job, being encouraged by a nurse who was gently stroking my arm. I then lapsed into unconsciousness again. The next time I woke I was much more aware of my surroundings, of all the tube spilling out of every orifice, of the banks of monitors bleeping away contentedly, of the nurse who was at my side. My Father visited me soon after I came out of surgery and was quite shocked at the sight before him. I started to gag of the tube. panic started to build up inside. The nurse gently told me to relax and take deep breath. It worked and I drifted off again only to be woken by an alarm going off. Someone’s died I thought. 'Come on Luke, deep breaths' Oh shit it's me. I was wired up to a monitor which goes off when you stop breathing, and for some reason you forget to breath.
It seemed an eternity lying there with that bloody tube in your mouth, unable to talk. I got pretty good at pre-empting the alarm and would raise my hand before it went off. All I wanted to do was rip that tube out of my mouth, but was told that I must breathe for myself before they remove it. I was concentrating so hard on staying awake that I would forget to breath. I was in the ICU for nearly 24 hours and at no time did I wake up to find that the nurse, my nurse, was not there.
The tube was the first thing to be removed. I was told that they would pass a suction tube down the ventilator tube to suck fluid off the lungs as they remove the ventilator tube. Great, I felt like an advert for Hoover. That was uncomfortable, making me cough and gag and for the first time I became aware of something sticking out of my stomach. These turned out to be chest drains, and these were the next thing to be removed and this is where I found the true definition of a 'little discomfort', as the doctor said. I have never experience pain like it. It felt like two barbed lances being withdrawn slowly one by one. What they actually looked like I don't know, I didn't see them. I had my eye tight shut. But whatever they looked like, they left two holes that needed stitches to close.
By 10 o'clock Wednesday morning I was taken to the High Dependency unit and was feeling a little more human if not in considerable pain. It took them the next 24 hrs to find a pain killer that suited me. It was not so much the wound in my chest that hurt, it was more painful in my shoulders and back. A nurse came to take some blood. I held out my arm. He put a syringe to my neck and attached it to one of the numerous tubes protruding from it. I didn't know they were there. It was then that they put me in a chair and the physiotherapist came to see me. She gave me a pep talk and told me of the importance of coughing up the phlegm left by the anesthetic. It was then that she passed me a small pillow which she showed me how to clutch whenever I coughed. Up until then the wound left by the surgery did not hurt at all; it was across my back and around my ribs that hurt, ached, throbbed. But to cough was something else. The following morning she came back and took me for a walk, or should I say more of a shuffle, along the corridor. This would be 48 hrs after the operation.
In the HDU they constantly took samples from various tube dangling from my neck, measured the amount of urine which filled a bag dangling from a tube which in turn was dangling from my penis. This had to be removed now that it was established that I was mobile enough to get to and from the toilet. The male nurse, who I'm sure I must be engaged to now, gave the discomfort spiel. It didn't hurt, it was rather a funny sensation. The tube is inserted up your penis and into your bladder and kept in place by a small balloon which needs to be deflated before withdrawing the tube. Clever stuff, but not painful. Nurses tell the truth doctor's lie. All other tubes were removed with the exception of two small wires which were hanging out of my chest. These were 'jump leads'. Just in case.
Later that afternoon I was moved to the main ward, the ward was mixed with little knowing smiles passing between patients but not much in the way of verbal communication. People were too busy healing. It was hot on that ward. I asked an auxiliary nurse if she would ring my wife to get her to bring in a fan, but it was unnecessary as she found one for me. This made things much more comfortable even though I got dirty looks from others on the ward who were sweating like the devil. Even with the fan I would wake in the night soaking in sweat.
Again the following day I was moved to a four bedded side ward. This was the last stage in the production line and this is where you persuade the doctors that you are fit enough to go home. It was on the Saturday that my heart started to falter; nobody seemed too concerned about it. Apparently it happens sometimes. Thanks for telling me. During the evening rounds the doctors told me that, If my blood/ warfarin count was OK, I could go home the following day. That took me by surprise, they might want to get rid of me, but I wasn't sure that I was ready to go. That night a nurse came to remove the last sense of security, at the removal of the 'jump leads' I would be flying solo. Scary stuff. She pulled the curtains around my bed in order to do the deed, at which I started to moan and cry out, as Meg Ryan did in 'When Harry met Sally'. As I got louder the nurse couldn't do anything for laughing and the Ward Sister and others came running, expecting to find someone having a heart attack. She was not best pleased.
There was a chap in the bed next to me who was also due out the next day, kept taking the mick, saying that I wouldn't be allowed out. We decided that we would arrange for our respective lifts to collect us after the Japanese Grand Prix. We were half way through it when a porter came for him to take him to x-ray. He looked at me and said 'You bastard'. He was still claiming that he was to be discharged as they wheeled him off down the corridor. You've heard of the saying ‘laughing fit to bust’ - well it nearly happened.
Well that was it. The doctors sorted out my medication, letter for my GP, nurses discharge list and I was out the door. The journey home in the car was extremely uncomfortable to say the least. But it was nice to be out with my family fussing about me. I arrived home, sat in the arm chair and promptly bust into tears - they didn't tell me that would happen.
On the Monday my wife took the GP's letter to the surgery and I waited for the visit or at least a phone call. Nothing - never mind, I had to have a blood test on the Tuesday to check for my Warfarin levels, he'll see me then. Nope. I was greeted by the nurse who asked what she could do for me. She didn't have any notes so I had to explain everything to her. I felt let down by the system and very much out on a limb, a limb which was about to break.
During the early hours of Thursday morning I awoke in a sweat to find that my heart was all over the place missing beats, speeding, slowing, stopping, starting. I lay still for the longest couple of hours in my life. Waiting of it to stop and not start. I didn't want to wake anyone, to worry anyone. I felt OK, just my heart was stuffed. In the morning I waited for the surgery to open and rang the doctor. I explained the situation to the receptionist who put me straight through to a locum, my GP was on holiday. His words were 'I guess you had better take yourself to casualty, it's up to you.' Yep, this was care in the community at it's best. Five days in hospital and just a week after major surgery. Tred water or drown, that's how I felt. I expected a little more from my own medical centre. Still, a good thing it wasn't anything serious, like a stubbed toe! Sod em'. I rang the Queen Elizabeth. An hour later I was being fussed over by a couple of nurses who were reassuring me all the time. Now I felt safe. It was not unusual for this to happen and it was decided that I would be taken to the theatre for them to stop my heart and re-start it, thereby inducing its natural rhythm. And so I waited. They were busy that day and it was not until eight o'clock in the evening before they came to get me. I wasn't unhappy, I felt secure. I was wheeled as far as the theatre doors when I was turned around and wheeled back down the long Victorian corridors. They had an emergency. I would have to wait until the morning. I could cope with that.
I woke in the middle of that night. And listened to the slow steady rhythm of my heart. Normal. So I was discharged for the second time, with tablets which would keep things steady.
And that was it to all intents and purposes. Apart form another, shorter episode and the odd missing beat I'm a right as rain. I have just had a visit to the out- patients dept, the post op thing. They were busy, and it took a while to get through the x-ray, ECG, etc., but the consultation was quick.
I think it should be compulsory for all government ministers to go through major surgery before deliberating the future of the NHS and the nurses pay awards. I walked down the corridors on Ward east 2 B and read some of the hundreds of cards which adorn the wall. Grateful patients attempting, sometimes struggling, to say something that is impossible to say. 'Thank you' is not enough, but what else is there.
They can stick there bloody food where the sun don't shine. Now, that WILL kill you.