I'll tell you now that the four-and-a-half days in the hospital after open heart surgery feel very distant. It was less than four months ago as I write this, but it seems much longer than that.
At the time, the ordeal was a magnanimous one, but now it is almost a speck in my rearview mirror. You might say it's out-of-body, because it's so far removed from your typical life, and then suddenly it's over and almost everything is back to normal. And normal isn't entirely a good thing. Normal means that shit continues to happen.
Life goes on, even as you struggle with the direct challenges of your recovery. For example, my fiancée fell two months behind in her grad school program because she was taking care of me. There was a serious decision on New Year's Day whether or not she had the gumption to dig in and commit to finishing her 100-page thesis by April, or if it would be smarter to pay an extra $5,000 and differ her final semester until the fall. Meanwhile, we were still planning our wedding for June. Then our condo flooded Jan. 18. As I write this in early March, the house is still in a state of ripped-up chaos as we wait for our new flooring to arrive. Like I said, Life (with a capital L) doesn't wait for you to feel better. It continues to throw hard balls. Be ready for it. During my hospital stay, I made the mistake of imagining that my recovery was going to be straightforward, as if that would be the main difficulty in the months ahead. Nope. This is why it's crucial to have a strong support system of family and friends, especially during the first two months.
I should add that "returning to normal life" has its good things, too, of course. I've been rock climbing again on toprope since Valentine's Day, and I climbed quite well. Much better than I'd dared to hope. Also, I've been able to take on more domestic responsibilities since January – such as making dinners and walking the dog every morning – which has helped Mandi get back on track with grad school. I've realized how great a difference it makes to have the physical ability to do so many little things I used to take for granted.
Anyway, I'll go into more detail about the recovery outside the hospital in another blog. The only other thing I'll say about the overall experience is that the hospital stay was physically traumatic over a short period of time, and perhaps analogous to the emotional challenge since then. Emotionally, this whole deal has been equally as traumatic as all the fear and pain in the hospital, but less tangible and spread out over a much longer time period. Be ready for that.
My first memory of waking up after five and a half hours of open heart surgery is vague except for one powerful feeling: joy. I'd survived. And my family was there in the ICU with me. I wanted to talk to them – I was so excited to be through it – but I had a tube in my throat, and tubes coming out all over my body.
Mandi said that waking up was a longer process than I remember. She said the drugs took a while to wear off and for me to regain full consciousness. Then again, it might not be accurate to say I had full consciousness at all until the following day. Waking up from surgery, I was in-and-out while everyone stood and watched. The decisive moment for me, however, was that feeling of relief, knowing that I came through OK.
I was floating on morphine, which is to say I had so many pain killers looping through my system, I couldn't focus on much of anything except the fact that I was alive. I was incredibly thirsty, but I wasn't allowed to have water until the anesthesia cleared from my body. Finally the nurse gave Mandi a sponge soaked in water for me to bite down on and wet my mouth. It was almost a tease, I wanted a cold drink so badly. Once the nurse said I could have a drink, I drank so much ice water I ended up with an upset stomach. Lesson learned.
I spent the rest of the night floating there, half naked in the bed. A variety of aches and pains nagged me too much to sleep, but the drugs kept them far away, like a muffled voice under my pillow. But I wasn't awake, either. I was in a sort of limbo I'd never experienced. As I mentioned in some earlier blogs, I'd made a long, uplifting playlist on my iPod to have during surgery, but that first night in the ICU is when I was most grateful to have it. The music gave my brain something to carry it along in that limbo state.
Wow, I just went through open heart surgery, I kept thinking as the light of dawn seeped through the curtains of my room.
Sunrise was about the time I started to feel a bit lonely. My family's anticipated arrival of 7 or 8 a.m. seemed a lifetime away. It also started to dawn on me that having many of the various tubes pulled out of me was not going to be pleasant.
A cardiac catheter was in the jugular vein of my neck and went all the way into my heart. It had allowed the surgeons to run diagnostic tests and scope the situation with a camera before cutting into my chest. I was glad I couldn't see it when a male nurse pulled it out. He made me hum as he removed the long, rigid tube. My humming was to reduce the risk of getting an air bubble in my circulatory system. The sensation was not something I'll forget, and it gave me a taste of what was to come.
Soon after the cardiac catheter was removed, a couple of temporary pacemaker wires that sprouted from my torso, a urinary catheter and an IV or two (I recall having three at one point, then two for the rest of my stay) were pulled out as well. Then it was time to try walking.
The physical therapist was at the end of her shift and was ready to go home. If I wanted to be moved from the ICU into general care, where I could have my own room and more privacy, I had to prove I was well enough. That meant I had to walk as far as I could from my bed and back again. Ten minutes earlier I'd just had the tubes pulled out of my body; I wanted to take a short nap before I tried to walk. There wasn't enough time. I would have to buck up and do the walking test now, or wait until the PT returned the next day.
Reluctantly, I sat up and grabbed the walker in front of me. The stern, young Latina woman treated me rather coldly, I thought. She had short patience for my moaning and I felt like a pig at a 4-H show being hustled around the ring with taps from a stiff little whip. I stifled the urge to vomit or pass out over the walker and shuffled about 100 yards total. The fun had just begun.
Now that my catheter was out, I was told to pee in a jug whenever I had to micturate. This allowed the nurses to measure my outflows. So began my desensitization to holding my penis in a jug for the world to see as I sat on the edge of a chair or a bed.
I've never been the shy pisser in public restrooms. I've always been able to pee at will. Of course I felt shy learning to do my business in front of anyone who was in the room, but that wasn't the full reason I struggled to void my bladder. The urine came out in forced bursts and little trickles, yet my bladder was aching for relief that wouldn't come. This was probably because of the drugs affecting my system, and it continued for about 48 hours after surgery. I'll talk about this a little more in a moment.
It was during my transfer to from the ICU to general care that I noticed how some nurses didn't seem to listen as well to what I was trying to tell them, that this or that hurt, etc. (To their credit, it's unlikely I was communicating as well as I thought.) For example, I had two large drains that came out below my ribcage. The tubes were connected to a couple of balloon-like containers that collected blood from my pericardium (the sack of tissue around the heart). The containers had to be emptied regularly. One tube was especially sensitive and I tried to tell a male nurse, who was new at the job, about the pain as he emptied one of the containers. He casually pinched the tube and squished the remaining blood down into the balloon by sliding his fingers down the length of the tube in a stripping motion. It felt like a vacuum was sucking on my heart. The pain of having my guts stirred in such a way was so intense and sudden that it cut me off mid-sentence. I was paralyzed for a moment.
"Oh, does that hurt?" the nurse asked.
I couldn't speak.
"Do you want some pain killers?" he asked after a long pause.
The nurses clearly wanted to do their best, but of all the ones I met, none had been through open heart surgery. They meant well, but they only had a theoretical understanding of what it felt like.
I have both criticism and empathy for the hospital staff. Until I was 17, I planned on being a doctor – a heart surgeon, no less – and I was in the med-prep classes in which we did internships as nursing assistants at the hospital. It was enough experience for me to appreciate how challenging it is to provide a high level of care for a great number of patients, who vary as much in their needs as they do in personality. Thus, I might be more forgiving on some matters and less so for others.
When they finally moved me from the ICU, hours after they said they would, it was in a wheelchair. Another young male nurse said he normally worked in the cancer wing and was filling in for someone. Which meant he had even less of an idea what exactly I was going through. He wheeled me to a bed in a cold room and parked the chair in front of it. In my mind I felt as though everyone was waiting expectantly for me to stand up and get in the new bed on my own.
Isn't he going to help me with this? I thought. I'd been trained to be hyper-attentive in these situations during my hospital internship half a lifetime ago. I should have asked for assistance instead of assuming that everyone was waiting for me to perform like they had during my test with the walker. I lurched from the wheelchair to the bed, shivering in the room that seemed so cold. Dizzy with fatigue, I couldn't even hold myself upright and allowed myself to collapse back onto the pillow. Except the bed was completely flat, as opposed to the elevated position. I slammed onto my back and my torso exploded with pain. I asked for a blanket and more pain meds with chattering teeth as the young nurse looked down at me, wide-eyed, probably feeling like he dropped the ball (or a patient).
At least I finally had my own TV and some privacy. The rest of the day passed by in one long sleepy stupor, until late that night when I had to pee in the worst way.
"Maybe you just feel like you have to pee – the drugs can have that affect," said a well-meaning nursing assistant.
"No, I really, really do have to go." I'd been sitting on the edge of the bed with my dick in a jug for the last hour. I'd managed little squirts here and there, but for some reason I couldn't drain my swelling bladder. It was hell. At first the nursing assistant hovered behind me for several minutes to give me a degree of privacy. When nothing was happening and she couldn't convince me to give up, she left the room after I swore that I was able to do this safely on my own. That didn't stop her from checking in on me every few minutes, standing in the open doorway of my dark room. At first I'd try to cover up when she came in, but soon I stopped bothering with any notion of privacy. I didn't care anymore who saw me through the open door with my junk hanging out. I just wanted to pee.
The well-meaning NA continued to hover and talk to me like she was mothering a 10-year-old boy. It annoyed me that she didn't believe how truly I had to piss. How I dreamed of pissing!
"I think this would be easier for me if you just left me alone. Really." I said.
She seemed hurt at the implication that she wasn't helping me, but she finally listened and left me alone with the jug between my legs. By midnight, I'd filled that sucker up one and a half times.
"Oh, you really did have to go!" the NA said.
By the end of the third day, I could pee easier and walk around my room pretty well (I think I had my first bowel movement, too, which of course was a bit belabored). I read and watched TV, but mostly I napped. My dad and Mandi were regular visitors and they spent a lot of time reading or talking quietly while I dozed.
I didn't have any tubes pulled out that day – the big drain tubes for my pericardium were left in until the fourth day – but they did wean me from IV painkillers. This meant I had to swallow pills from then on, and they weren't as strong or fast-acting as the drip. They started me on a very conservative dose of Oxycodone, at 10 milligrams. I ended up watching the clock for hours until my next dose. Eventually I convinced the nurse to up the dose to 15 mg every six hours.
"Ten milligrams is like what they give to little old ladies," one nurse said later in disbelief. The point is, painkillers are something the hospital basically makes you ask for.
On day three I also took my first shower, which was part of the bathroom attached to my room. I felt better after washing my sweaty skin, but it took a lot of effort, especially since I had to carry the blood-filled bottles attached to the end of my sensitive pericardium drains along with a heavy electronic monitor that streamed my vital signs to a computer at the nurses station.
One perk of my situation is that, as a healthy young man, I had no dietary restrictions. I could order whatever room service I wanted! The doc even encouraged me to eat whatever made me happy. Still, I didn't get much of an appetite until the end of the day. I ate mostly soups and simple foods with juice. By the end of the day, though, I was ordering crab cakes smothered in hollandaise sauce and cheeseburgers with onion rings. The room service attendant couldn't believe it.
"You're a heart patient? You're sure you're allowed to order this?"
"Yes," I said.
"I'll need to check with your doctor first."
The room service certainly added an element of fun to my hospital stay.
The Broncos lost miserably to the Patriots and my last drain tubes were pulled out, which made it a tough day. Again, the nurse didn't seem to pay attention to my warning that one of the tubes was particularly sensitive.
"It'll be like pulling a stitch – it won't hurt at all," he said as he went about pulling the most sensitive tube with casual abandon. I started to tell him, "Bullshit, let me have some painkillers first," but, again, I was cut off mid-sentence by the paralyzing pain of the tube being pulled from my chest cavity.
The doctor came by and floated the possibility of discharging me that day. I remembered how I felt when I allowed them to move me out of the ICU before I was quite ready, and declined the offer. I would have a three-hour drive to get home, and I wasn't exactly feeling tip-top. No thanks, I told the doc. I was glad I stuck to my guns, because going through discharge the next day was exhausting in itself. (Keep in mind that any hospital wants to free up as many beds as it can whenever possible, so hold your ground if they're pressuring you to discharge before you're ready.)
Discharge started around 8 a.m. but the process took hours. The doc had to do a final check up. Nurses came by to lecture me how to handle myself once I was back at home. There was endless paperwork to sign and prescriptions to fill. Our goal for check-out was 10 a.m. but it was early afternoon when we finally got out of there.
Mandi drove and took lots of rest stops for me as I tried to relax with a pillow between me and the seat belt. (Seat belts still irritate the scar on my chest.) Plan carefully if you have more than a one-hour drive to get home after discharge. Don't underestimate how hard it can be to sit in a mostly fixed (and vulnerable) position for so long.
We stopped by Ragged Mountain Sports, the shop where I work, on the way home to show off my scar. I felt great, but I had a loooong way to go.