It's Deju Vu All Over Again...

I have to admit now, looking back from a distance of a couple of years, that part of me was tempted not to have the second procedure. By this time I had read about and was well aware of the relatively slight dangers of an angiogram and the much greater risk of having another angioplasty. I wanted to find some good, or even not so good, reason to say that a second operation was unnecessary, thus avoiding the seeming inevitability of having to go through the same thing all over again.

There were some signs that part of my problems may have been down to the medication, I had been prescribed beta blockers which had the effect of making my already slow heart rate even slower. Indeed, on the first night in hospital, it had regularly been recorded at around 42 beats per minute. Such a rate is fine for a high level marathon runner or someone intending to take part in the Tour de France, it is not so good however for a middle aged gent leading a somewhat more easy-going lifestyle.

Dr. Amersey, on seeing the charts, immediately changed my now long list of medications to exclude the beta blockers and also reduce the statins intake. My cholestrol reading had come back as 3.6; relatively low and not really in need of being controlled by medication. In view of these changes, I was tempted to ask for a reprieve, say two or three weeks, to see if the new regime changed the way I felt, and thus avoiding the need to undergo another procedure. Feeling I had dodged a bullet the first time, I felt no particular enthusiasm to put myself in the firing line once more.

The doctor, calm and logical as ever, explained the advisability of taking things a step further. Given the nature of my condition the risk of not undergoing the procedure was far greater than then risk involved if it was avoided. There was still some reluctance on my part but I understood that, in real terms, it was the most sensible course of action.

So it was that I found myself signing the consent form once more. There was a sense of surrender, a sense of ‘que sera sera,’ whatever will be will be. For me, oddly, there was also a sense of peace in that inner surrender and I found myself surprisingly calm as I settled down to await the procedure. I had been told I was second in line so to just make myself comfortable for a while until it was my turn.

I had just opened a copy of ‘Alex’s Adventures in Numberland’ when the doctor suddenly reappeared.

“Sorry George, the previous operation has been cancelled, you’re next!”

And so it was that within a bare few minutes I found myself once more being wheeled into theatre. A lot of the nurses were, by now, familiar from a fortnight before.

“Back so soon?” one of them asked, smiling.

“Yes, I enjoyed it so much the first time that I just couldn’t wait to come back for more… ” I explained.

Once more the nurses busied themselves with the usual attachments, once more I was positioned on the long, narrow bed, my hand tucked beneath my body, once more the brief explanation as to what was going to happen next.

Having punctured my oh so sensitive right groin the first time, it was now decided that they would go in through the left side. A young doctor, trying hard to affect a level of nonchalance, injected the lignocaine into the top of my thigh and proceeded to attempt to feed the needle into the femoral artery. The process did not go well however and, several times, I was told to ‘relax.’ Not the easiest or most natural thing to do when someone is trying to puncture a vital artery in a very sensitive part of your anatomy, followed by pushing a rather large needle into the hole thus created...

Dr. Amersey took over at this point. I felt it as something of a relief to be back in his capable hands. Within just a couple of minutes the dye was dispersed once more into the arteries of my heart and then… silence. For a minute or two all I heard were a few faint mumbles as the team went into something of a huddle.

Eventually, Dr. Amersey appeared from behind the perspex screen, a look of some concern on his face. I had seen this expression before. In fact this was the third time. Deja vu all over again…

“We have had a look and although the first two stents look fine there does seem to be something of a blockage in a branching artery.”

He waited for a response but what could one say?

“Go on.”

“Well, from the previous images we looked at, the blockage would appear to have developed in the last couple of weeks.”

He let the implications of this sink in for a second or two. The obvious question was why would it have developed now when the flow of blood around the heart should have been improved by the previous stenting?

“I think the best course of action would be to insert a further stent into the branch artery… with your permission?”

Again, what can one say in such a situation? As the patient you are caught between a rock and a very hard place. Potentially damned if you do, almost certainly damned if you don’t. Not a real choice, you have to go for it. I nodded my assent.

“OK, thank you. By now, you know what to expect,” he said, with a certain underplayed irony in his voice, “It’s possible you may feel some build up of pressure in your chest. Let me know if it becomes too uncomfortable.”

With this he disappeared once more behind the perspex screen and made his preparations. Lengths of catheter tubing were requested along with a smaller size drug eluting stent than the previous two. In but a few short minutes all was ready.

I listened to the soft voices of the doctor and the team, calm yet focussed, reassuringly concentrated on the task in hand: rescuing my ailing heart. Within a minute or two the catheter was being inserted. The next stage involves guiding the stent itself up through the arterial system. In theory, one cannot feel any of this directly but you do notice small changes in pressure in your chest. After all, the flow of blood in the arteries is outward, away from the heart. The sheath, catheter and stent are all opposing that flow to various degrees.

Somehow, this time, although more aware of the dangers than previously, it felt easier. I was well aware that there are risks involved but I felt a high degree of confidence in the team of people performing the task. There was something very reassuring in the professional manner in which they worked. Requests would be made, curtly yet politely, responses would be made, quickly and accurately. If there was a problem it was quickly and efficiently dealt with. The thought crossed my mind, this procedure may not end well but it would not be for lack of effort on the part of these people.

Soon I heard the now familiar count once more: “Going up, 2,4,6,8, 10 and 12…stopped at 12.” The count was spoken once and then echoed in confirmation. I felt the pressure climb in my chest. For a brief moment it was actually quite uncomfortable. I waited for a few seconds, still felt the pressure, and so pointed it out to the doctor.

My comment was acknowledged but, fortunately, almost immediately the feeling of pressure subsided. For a few more minutes there was the sound of muffled conversation from behind the screen, as hard as I strained to hear I could only pick out the odd word here and there.

The doctor pushed back the screen. He smiled briefly, reassuringly, before telling me that he considered that it had gone well. The only downside was that a blood blister had appeared beneath the site of the opening in the femoral artery and they would therefore not be able to plug the wound in the normal way. Pressure would need to be applied to the site for some time in order to get the wound to set.

I was relieved to have made it through once more and the prospect of some pain as the left groin area was pressed firmly immediately over the wound seemed, relatively speaking, of little consequence. I have to admit though… it really did hurt!

The nurse apologised a couple of times for causing me such pain but there was no need. Pain inflicted when one is aware that the intention behind the process is your well-being is much easier to bear.

In no time at all I was back in the familiar environs of Elizabeth Ward. It felt like I had hardly left the place. Many of the same staff I had met the first time around were on duty once more and it actually felt good to be reacquainted with them. For the first few hours I was confined to the bed, most of the time spent completely horizontal to give the wound a chance to heal properly. After about three hours I was allowed to gradually increase the angle of my body until, finally, I could sit up in bed.

My younger brother, David, appeared at this point. It was good to see him once more. We chatted away for some time. David tends to be in one of two modes, the first is rather self contained and one struggles to eke even a few words out of him, the second is much more open, voluble and effusive. Fortunately, on this occasion, he was very much in the second mode and the conversation flowed easily and interestingly. The only downside for me was the ongoing effects of the diamorphine I had been given which rendered me a tad sleepy at times.

A couple of hours later it was time to knit the wound together. This involves more pressing on the groin. The pressure needs to be very firm for it to work so there is an amount of pain involved for the patient but it also tends to be hard work for the nurse. The sister who was to carry out the procedure was in charge of the ward that evening. She was of a somewhat slight build and the sheer physicality of having to try to hold the pressure on the groin for that length of time was clearly quite a strain. She stuck to the task however and, after the fifteen minutes and numerous apologies for causing me discomfort, the wound was sealed. I think we were both quite grateful!

The week following the second angioplasty was both better and worse than previously. Better in the sense that, although I was not exactly glowing with health, the improvement was clear. I no longer experienced the breathlessness I had before and the light sensitivity seemed less intense. The downside was the injury to the groin, collateral damage from the procedure, as our transatlantic cousins might term it. The bruising was a sight to behold as it came out over the first few days. Gorgeous long lines of purple, separated by about six inches, in between which the skin was a strangely exotic shade of muddy yellow.

Walking, even very short distances, was more than a tad difficult for a few days. My cat, Cooking Fat, often seems to display a certain empathy at one level, oft times sleeping beside me when I have been low. On another level she displayed an almost criminal disregard for the sensitivities of my much bruised groin by leaping unexpectedly onto my lap from all angles and at any time. Not so good…

There was a feeling of gratitude that persists to this day. I feel grateful to the people who have helped me on this occasion, grateful to those who helped me on previous occasions, grateful simply to have come through at all. Several times in my life it could have turned out very differently. In particular, I am grateful to the NHS and the staff therein. They come in for a lot of criticism at times but I for one have good reason to be thankful to both the institution itself and the staff within.

I had gotten through the worst of it, now it was time to figure out how I could avoid going through the same thing again, if at all possible...