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Sunday, 14 October 2012

42. STRANGE ARE THE WAYS OF HEART


“I am having burning sensation in the upper abdomen,” said hubby.
“What do you expect if you keep watching the TV the whole day?” I couldn’t help being sarcastic.
“Take some antacids. It must be the Chinese food we had last evening.” 
But neither Eno nor Tums seemed to be effective.
“You guys have given up on all your exercise of late. Why don’t you go for a walk? The weather is so nice outside,” suggested our son.

The two of us set off for a lazy post dinner stroll. Five minutes of walking and he says, “I am not comfortable…am having some funny feeling in my upper abdomen. Let’s go back.” And we turned back.

In the morning, he shared that he felt a strange discomfort in his chest when he climbed stairs… a kind he had never experienced before. We were alarmed. Let’s go to the doctor, was the unanimous view.
And we headed off to an Urgent Care Centre in this small city of US Mid West. The doctor wants to do an ECG. But the machine has just conked off. He suggests that we get an Ambulance and take him to the Emergency Care of the Hospital.
“What rubbish!” hubby exclaims. “Let’s go home and have lunch. I am feeling hungry and perfectly ok.”
And we go home and have our lunch. Hubby goes up and down the staircase and flaunts, “See. I’m alright now. No need for going to the Hospital.” Was it the escape-artist in him, I wondered.
Lunch is over but both I and our son are concerned. We insist that we go to another Urgent Care Centre. The Doc on duty sees him and says, “I can do ECG and a much needed blood test too. But I can give you the result only tomorrow morning. I’m afraid it may be too late by then. You better take him to the Emergency Care of the Hospital right away.”

We were alarmed. “This sounds bad news. Let’s go straight to the Hospital,” concern was evident in our son’s voice. Thus despite hubby’s resistance, we reached the Hospital Emergency Unit. And the real-life drama that unfolded that afternoon, lasted for the next twelve days…..

A Heart Monitor 
As soon as we arrived at the Reception of the Hospital Emergency and shared the reason of our visit, the girl at the counter dropped everything and rushed to get a wheel-chair. Hubby is amused and laughs, “I came walking from the Parking.” But she insists that he sits in the wheelchair. He is briskly wheeled into a room…. Room No 113. The Doctor on Duty reaches there simultaneously. An X-Ray machine has come and chest X-ray taken, ECG machine is wheeled in and ECG done, blood sample is drawn, oxygen has been placed on his nose and an IV (Intra Venous) drip administered.  All this happened in less than ten minutes. In another few minutes, the Doctor on Duty had confirmed by looking at the Blood Report and the ECG that he had suffered a heart attack, may be a few days ago. We are told that a Cardiologist is on his way.


The Cardiologist arrives in no time and prescribes the further course of treatment. Hubby is now being moved to a room on the 3rd Floor… Room No 313.  I notice the number 13 coming my way the third time that day but keep quiet. Why allow my mind to run unnecessarily into irrational directions, I thought.

View from CCU
As we settled in the room, the Hospital Registration people came in seeking details of his passport, local address and Insurance Company who will foot the bill etc. We are confidently carrying a Travel Insurance which covers him for USD 200,000. Wasn’t it wise of us to have taken such a huge insurance, I muse. Some signing of papers and documents etc. and we were in the room, experiencing for the first time, life in a US hospital.


As soon as we are left alone, we trigger off our network. First of all, inform the elder son in Canada, then my doctor brother back home in India and my doctor nephews in the US. We need support from all quarters.


Hubby’s condition appears to be stable. But will we have to deposit the entire cost of treatment up-front as we do in India? I can mobilise money back home but here I am carrying limited foreign exchange by way of a Foreign Travel Card. The night is spent worrying about his unexpected heart-attack and in figuring out how I will manage the finances. Will he be able to get the treatment he needs?  


Trnng…trnng…… the phone rings early morning next day. It is our elder son from Canada, “Hi Mom, I am on the way to the Airport…will reach there by noon. This is the earliest flight I could get.”


The Cardiologist visits. He has seen the early morning blood reports, has reviewed the vitals and announces, “We will have to do angioplasty on him.” We are stunned. The doctor is very understanding and says, “You may discuss amongst yourselves and let me know. I’ll come again after an hour,” the doctor’s patience was admirable.


Elder son has arrived and so has the doctor. With both my sons firmly by my side now, I was breathing easier. We discuss with hubby and he signs the consent for angioplasty (a procedure for inserting a stent in the blocked arteries of his heart).


Hubby in the hospital
Immediately, he is wheeled into the Cath Lab where a stent will be put in his heart to open the clogged mischievous artery. Wishing him well, we all wait in the lounge. After half an hour, a Nurse comes and announces, “It will take some more time.” Another 20 minutes pass in total silence and the Cardiologist steps out. He looks concerned, “We could not do angioplasty on him. There are too many blockages. Come with me.”

In the room, he shows us the angiogram, a video where we all could see hubby's pumping heart with multiple clogged arteries with two major ones blocked at Y junctions where stent cannot be put as the artery branches off into two.

“I am recommending a bypass surgery. Will talk to the Cardiac Surgeon,” he said.
We were directed to the CCU (Cardiac Care Unit) where he had been shifted to recovery.

The Cardiologist has been trying to line up a Cardiac Surgeon but is not successful. “Anyway, you guys don’t worry. Even if I line up with a surgeon, he will not be able to do any procedure before five days …until the effect of these drugs taper off from the system,” he comforts us before leaving.


The doctor leaves and we are sitting in suspense the whole day. The evening dawns and the Nurse informs that we have to shift to the room now…Room no 313 again.


At night before leaving, I hesitatingly ask the nurse on duty whether we can get a CD of his Angiogram which we had seen, maybe by tomorrow. Expecting a curt ‘No’, I was pleasantly surprised to hear, “Yes, of course! Let me see if the concerned person is available. I’ll give it to you in ten minutes.”

Armed with CD of the angiogram, I talk to the Doctor back home in India. He wants to see the angiogram. The file size is big. It is not going with the e-mail as an attachment. We keep struggling and finally the boys manage to do some technical jugglery and send the links to the doc in India. E-mails sent, we go to bed past midnight.


In the morning, we contact the doctors in India. The cardiologist over there advises, “It is only a mild heart attack. You can easily bring him back. Ask the doctors in the US to do medical management. Surgery can wait.” 


In the hospital, we suggest to the Cardiologist medical management of the patient. He refuses point-blank, “He is not stable. I have given him every possible medication, but he still has some pain. If I remove these drugs and allow him to go out, he sure will have a massive heart attack and you will come back here again by calling 911. I am the doctor on the spot and I know the condition of my patient better than anyone else.”


Next day, I wake up at 5am. It is not possible to sleep anymore. I fix up my cup of morning tea. My elder son also comes down to the kitchen. He quietly fixes up his coffee. As we sit on the deck sipping our morning cuppa, he says, “Don’t worry, Mom. We’ll do our best. Don’t bother about the money either. We will take care of everything.”


The stress is becoming too much. The uncertainty is killing me. That night as I hit the bed, I want to cry burying my head in the pillow. But tears do not come. Instead, what I hear is a sudden pounding heart. The heart beat is going up. It is so clearly audible and is becoming louder by seconds…boom boody boom boody….oh my God! What is happening to me? I try to take charge of myself, try to calm down, try to relax, whatever I could think of in those awful moments. Noooo…I don’t want to fall sick at this juncture….not at this time, not at this place.

Finally, a Cardiac Surgeon arrives, looks at the reports, sees the angiogram and gives his verdict, “It is not possible to perform a bypass surgery for a variety of technical reasons. More than 10% chances are that you may die during the bypass,” he declares.  Can anybody be so straightforward, I wonder?


The ball is again in the court of the Cardiac Interventionist who had already ruled out putting a stent earlier. He says it is not possible to put stents due to the location of the blockages and leaves. But then we knew this 10 days ago also. Didn't we?


What do we do now? Interventionists say stent is not possible. Surgeon says bypass surgery is not possible. And the Cardiologist says that if you step out of the hospital, massive heart attack cannot be ruled out. What do we do? Fly him to India? What are the risks involved? If he suffers a massive heart attack on the flight, what will I do except watching him helplessly. But what are the options? The mind is going numb. I am finding it difficult to think and decide. Have all doors closed?


An hour passes in a state of limbo. A young doctor in his early thirties comes again. He is now beaming, “Yayyyy! There is hope. I have contacted some senior doctors who have found a way out. They can put two long parallel stents at the points where arteries are branching off. ”

I am still skeptical and blurt out, “How many such operations have you done, Doc?”

“None,” the doctor is honest. “But the Senior Doctor has done a few of them. This is the only way for the patient.” I am amazed at his calm tone despite my brusque query.


We seek time. A doubt arises... is my poor husband being made a guinea pig? But what is the alternative?  Anyway, another weekend is approaching and nothing will happen for the next 72 hours. Keep thinking, keep worrying.


On Monday morning, as we do not see any other alternative, we sign the agreement for the procedure.  He is wheeled into the Cath Lab once again. We kiss him luck and wait in the Lounge. Half an hour passes. A nurse comes out, “The patient is doing well. The Doctors are on the job. It may take another hour.”


Inside the Lab, the patient is wide awake and is fully aware of the environment and the activities around him. He has not been given even local anesthesia...not even a sedative. He can see everything, hear everything, feel everything. Two doctors are controlling the movement of the catheter while the third one is guiding them. “Push it further by .25mm. Yes, move it a bit more…No, no, a little backwards.” The mattress underneath is changing position automatically from time to time.


The Lobby outside the Cath Lab where we spent hours of restless waiting
Outside in the waiting lounge, all of us are trying our own individual methods of keeping our minds calm. Lobby, Lobby in the hall? Who's the tensest of them all? Difficult to say.
Two and half hours of impatient wait, two and a half hours of worrying ourselves to bones, two and half hours of sinking into depression and bouncing back to eternal optimism. The wait was finally over when the doctor walked in to announce that all was well and that they have managed to put five stents in his heart including at those crucial locations by merging them or putting them in parallel. He guided us to a room where he showed us the angiogram of his heart with stents in it after a grueling process and the smooth flow of blood in them.


In next ten minutes, we were ushered to be with him in the CCU. He was smiling away. What a relief! Oh my God! And suddenly we realized how hungry we all were! Time to go and pick up something from the café to eat.


In another four hours, back to Room No 13 on the 3rd floor, I realized that the number 13 which had been with us all through had actually been lucky for us. 

The journey, that started on the 13th day of the month, had to culminate in room no 13 only and it did. Who said unlucky 13? It was Lucky 13, which helped my hubby all through!  

(A real life incident)


The Hospital
*****


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