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...

The Phoney War

Back on the ward, there was a feeling of relief, a feeling of simply not wanting to be in this same situation again in this lifetime if I could help it. The wound was uncomfortable but I knew this was just a temporary setback. It seemed that, for now at least, I had come through relatively unscathed. A few words from Churchill came to mind; “There is nothing quite so exhilarating as being shot at without result!”. Exhilaration may have been too strong a word in this case but there was a definite sense of having ‘dodged a bullet.’

After an angiogram/angioplasty procedure one is confined to bed for several hours in order to allow the wound in the groin time to heal. In this particular case, they had inserted a plug into the hole in the femoral artery, a relatively modern technique which avoids the need for a lengthier and more painful procedure whereby the site of the wound is pressed upon very firmly for some 15 minutes or so. For those of us who are a tad sensitive in the groin area, the very thought of it brings tears to the eyes!

For the next day or so, until the moment I escaped the confines of Whipps Cross Hospital, I was feeling strangely elated, almost slightly euphoric. Whilst in the limited spaces of Elizabeth Ward my increasing mobility and sense of general well-being were very reassuring. On the Tuesday morning I found myself busily engaged on the phone arranging all manner of things that needed to be done for those around me and myself. It felt good to be in charge of one’s life again, instead of just a passive victim of circumstance. As much as I appreciated the care and attention of the staff in the hospital, there was still a strong desire to be released from their ministrations and, once more, to feel oneself a free and independent person.

Before leaving I was treated to a visit from Caroline of rehab who offered enlistment into a program of exercise for those who had suffered a heart attack. I let her know of my limitations (the back injury) in such areas but gladly accepted her offer. Next came the rather exotically dressed lass from the pharmacy, a sight for slightly sore eyes resplendent in figure hugging dress and knee high boots, dispensing drugs and advice on how to take them. The list of medicaments was long, seven in all if one doesn’t count the ‘emergencies only’ GNT spray. There were statins, ACE inhibitors, anti-platelets and even beta blockers. I was a tad concerned at the last as my heart rate is pretty slow at the best of times but I was assured that in this situation it would take a load off of the embattled organ.

Phil Johnson, a good and trusted friend of many years standing. picked me up at around half three in the afternoon. He carried my bag along a section of the seemingly endless corridors of Whipps Cross. He was not walking particularly fast but even so I had to ask him to slow down. The light outside seemed somehow brighter than usual even though the day was overcast. I waited near the outpatients  department and enjoyed the sights and sounds of life going on around me once more.

Phil drove at a reasonable pace back to his maisonette just off Hermon Hill. Although his driving was by no means unreasonable, I still seemed to feel every bump along the way. On arrival, I got slowly and tentatively out of the car, feeling surprisingly vulnerable and frail. This was not at all what I had expected. I was well aware that I had had a heart attack but, at the same time, had felt like I was getting stronger and stronger, particularly during the previous 24 hours. That was in the hospital though. Now, exposed to the outside world, it was becoming obvious that all was not yet well.

I stayed with Phil and his wife, Simone,for several hours, most of which was spent strewn across their huge red sofa, being supplied with all I needed for the evening. They both seemed somewhat concerned, I think I may have looked even frailer than I felt. Eventually, around ten or so, Phil drove me home.

The next week was spent very gently reading, writing a little, waiting for the expected recovery. Indeed, for a time, I did seem to get a little better but would still find myself breathless climbing stairs and would still experience moments of faintness. The bruising in my groin and upper thigh was impressive, gorgeous shades of purple, blue and yellow. As ever, I rationalised my lack of a faster recovery, if my groin and thigh were like that then it would seem only natural that something similar had occurred internally. Recovery would be a matter of patiently waiting for the bruising internal and external, to subside.

I had been encouraged to take some exercise when I could so I went for a short stroll beside a lake in Wanstead Park. It was a sunny day and pretty soon I found that I was reacting badly to the light. After just a few minutes I had to sit down just  to allow myself the chance to recover. This wasn’t the recuperation that I had hoped for.

Over the next few days I struggled on and, after a couple of weeks or so, I was actually feeling a tad more comfortable, although the photo phobia seemed to grow more and more bothersome with every sunny day. Two friends, John and Erica, had invited me to share a trip to the British Museum to see an exhibition on early European Christianity’s addiction to the notion of relics. It sounded interesting so I decided to take a chance and embark on my first trip to London for a month.

I had only just started driving again which felt like something of a liberation.  I left the car in a side street close to Woodford Station and tried to walk the short distance to the ticket office. It was a sunny day and immediately the photophobic effect was obvious once more. Every white, or even light, coloured wall  or surface seemed to glare unbearably. It felt a little like the snow blindness I had experienced in Austria many years previously, this time though it was accompanied by feelings of light-headedness and even nausea. When I reached the barriers I was feeling quite ill and had to make a decision whether to go or stay; once through, I was more or less committed to the journey.

With some reluctance I decided to go. Taking the seat on the train I immediately felt better and was relatively fine until reaching my destination, Holborn. Once there though, I had to walk a short distance to a coffee shop where we had decided to rendezvous. Reaching the meeting point, even though it was but a short distance, became a struggle, so much so that I could feel the sweat running down my back at the effort involved. Every light coloured surface seemed to be breaking up into darker blotches. Finally, and much to my relief, I reached the basement of the coffee shop. John and Erica were already there and looked concerned at my discomfort. After taking a seat in a deep and cosy chair  and chatting with some expectation about the exhibition I soon became much more comfortable.

The exhibition itself turned out to be a beautiful presentation of a variety of relics from the early Christian era. Across Europe in the middle ages, all manner of relics recovered from the crusades were revered for having been involved in the story of Christ. There were splinters from the cross, a piece of bread from the last supper, even a towel said to have been wrapped around the head of Christ as he took the cross upon his back. All incredibly implausible of course, but bread (literally in the case of the relic!) and butter to the early Christian church. People would make pilgrimages in order to have a chance to even simply be in the proximity of such relics. Added to those connected to the Bible story there was also many artefacts connected with various saints. Many of these were body parts taken from the corpses (allegedly!) of martyred saints immediately following there martyrdom. Quite gruesome and, in many cases, equally implausible.

Coming out of the exhibition I still found myself weak and a little breathless but I did seem to be managing the demands of the situation quite well. Strange, looking back at it now, that same process of  rationalisation that I mentioned in a previous blog, that same willingness to believe the more mundane explanations for one’s symptoms, served to prevent me from the realisation that I will still in trouble. This process seems to be a defence mechanism that many of us share, a way of shielding us from the harsh realities that confront us at times in life.

All this was to change just two days later. I had been invited to undergo an exercise test at Whipps Cross to see if I was ready for the rehab program. It consisted of walking on a running machine whilst the operator, a sympathetic Irish fellow by the name of Brian in this case, gradually increased the inclination of the apparatus.

For the first half a minute or so I was OK. My body was festooned with connections so my heart could be monitored during the process and, at first, nothing unusual was apparent. Then the slope was increased. Within seconds the chest pain returned. I soldiered on. The inclination was increased and, almost immediately, so was the discomfort in my chest. I started to feel quite faint. Brian, monitoring the ECG and enquiring as to how I felt, decided quite suddenly to stop the test. He looked somewhat perturbed.

“George, I think you should come back into hospital” he said.

“Hmm, bit inconvenient right now Brian” I responded, “When do you think it could be arranged?”

“I think now would be the right moment!”

I had made all manner of arrangements for the coming days but I could see from the look on his face that he was quite concerned. I enquired if it was at least OK to return my car home and get a friend to bring me back but even this was, according to Brian, inadvisable.  When he said now he really had meant it and so it was that within a few minutes I found myself sitting in a wheelchair being wheeled along the interminable corridors of Whipps Cross back to Accident and Emergency to undergo further tests with a view to readmitting me.

Back to square one it seemed. There was some concern amongst the staff in A&E that I was having a second heart attack there and then. More electrodes were attached to my chest, ECGs were taken and samples of my blood were extracted from my much punctured arm.

My basic nature is, fortunately, inclined towards the optimistic, but, sitting there in A&E with little idea as to how serious this latest event might be, I have to admit to getting just a tad fed up with the vagaries of my heart.

If you can wait, and not be tired by waiting...

It was a time of good news, a time of bad news, a time of hope, a time of despair, a period of….hmm, getting a little close to plagirism here, don’t want to risk being sued by the Charles Dickens foundation. Over the next few days following the heart attack, or myocardial infarction to use the technical term, there were many ebbs and flows in my perception of what had happened to me. On one level there was the thought: “Why me?” On another, one could frame these events in such a way that one perceived oneself as being essentially very fortunate. Fortunate to be alive in the first place, fortunate to have suffered no worse damage, fortunate that the problem was now apparent and could be addressed.

The first visit on that Friday morning was from a Dr. Fen Lie, looking very inscrutable and somewhat like a villainous character from a Bond film, who came accompanied by his many courtiers. Whipps Cross has, in recent times, been designated as a teaching hospital so such visits tend to involve multiples of keen young medical practitioners anxiously trying to ask the right questions. They were also accompanied by a young echo-cardiologist who ran a hand held scanner over my chest and prognosticated on the results to all and sundry. At least most of her prognostications were positive though, which, at that time, was felt by me to be very reassuring.

I spoke for a time to Dr. Lie and expressed a little of my surprise at having a heart attack. I had previously thought that I was at relatively low risk compared with the general population. After all, I didn’t smoke, at least not for fifteen years and then barely the odd puff in the garden with my ex, Natalie. I didn’t drink, well hardly, maybe a pint of beer or a glass of wine a month. I had been a vegetarian for the best part of thirty years and, despite having long terms back problems, I still managed to swim three times a week and thereby kept myself fit. All those, I had thought, would mitigate most of the adverse affects that the course of time would take on my body, or at least slow such things down. Not so apparently. The flemingesque Dr. Lie’s response was an enigmatic shrug of the shoulders and the suggestion that whilst I awaited the proposed intervention, an angiogram followed by the possibility of angioplasty, I should listen to music.

Sound advice, if a little odd... Afterwards I wondered what he had in mind and pondered my choice from the classical baroque of Mozart to the more strident opus of Black Sabbath. I decided to lean towards the former... By now it was Friday morning and I discovered that I had timed my heart attack to take place at almost the perfectly wrong moment. There would be no place for the procedure that day and, as the weekend was to follow, I would have to await my fate until Monday morning.

War has been described as 95% boredom and 5% terror. Life as a patient awaiting a procedure, the anticipation of which does not fill one with particularly positive expectations, could be spoken of in similar terms. In an odd way though, having 72 hours during which I was compelled to wait whilst at the same time being discouraged from any overly physical activity actually began to feel like an indulgence. I found myself reading, and really enjoying reading, in ways that I had not had the time to do for what seemed like ages. My fayre was a mixture of articles in The Times, a novel from Anne Rice and some very technical books on hypnosis, all of which I found quite absorbing in their own way.

It’s strange but, in such situations, one is obviously very much aware of one’s own mortality and yet I found I had no particular regrets, no need to find any more peace than I already had, nor even any particular need to solve any great existential questions. I have, over the course of my years in this form on the planet, come to my own conclusions and oddly, despite the seeming urgency of my situation, I felt no need to change any particular attitude. I did not want to die, in fact I rather liked the idea of a long and healthy existence after this episode. I felt no great fear of death either though. Again, when I think of the anxiety such thoughts gave me as a teenager, the peaceful acceptance of my own mortality, and mortality in general, allowed me to easily stay in a surprisingly peaceful state of mind.

I spent some time, particularly after lights out, pondering what else was important to me but could only reiterate what I had thought previously plus some thoughts about friends. The one thought that did come to mind was how important it is in life to develop friendships and friends. To help, in whatever way one could, one’s friends and those close to you to develop in ways that are right for them, respecting, at the same time, their individual uniqueness.

Friends were, in this situation, an absolute boon. At times, I am not always the most social of characters and often enjoy long spells of my own company, but in this situation the love and friendship of those close to me was more appreciated than ever. I was surprised by how many made the effort to visit me. Each and every visit was much enjoyed. I count myself fortunate indeed to have so many intelligent, interesting and considerate friends. Out of respect for their privacy I do not want to name individuals here but each and every visit, each and every text, each and every call was appreciated. Some would make me smile, some gave pause for thought, each helped in their own way so a hearty (!) “Thank You” to all.

Now it was just a matter of waiting for Monday morning and the proposed angiogram. Having experienced the procedure once before during an erroneous misdiagnosis a few years earlier I had some idea what to expect, so it was with some trepidation that I fell into a fitful and dream filled sleep late on Sunday evening.