Don't Stint On The Stents...

At the centre of the theatre was a long, narrow bench above which were an array of screens. At the head end of the bench was a heavy scanner on a semi-circular tracker. I was laid upon the bench which, for a change, was actually comfortably long enough to support my elongated frame. Four or five nurses buzzed around me, fixing a drip to the cannula in my left arm, attaching numerous electrodes for an ongoing ECG, placing my right hand beneath my buttock and then, all needed preparations completed, sliding a long, lime green, paper sheet over me.

I looked up at the ceiling where someone had thoughtfully provided an impressionistic scene of Epping Forest, canada geese wondering around a muddy pond. The nurses chatted reassuringly as they busied themselves with a multitude of tasks. Finally, Dr. Amersey came in and briefly went over once more the likely sequence of events. Normally, he explained, they would consider using an artery in my arm to gain access to the arteries around the heart but, in my case, the tubing that was normally utilized may prove too short for the task so they were proposing going in through the femoral artery in the groin.

All I could remember of the femoral artery was what I knew from reading Hemingway’s ‘Death in the Afternoon’ as a teenager. The femoral artery was the one place that the bullfighters in the book feared being gored as, once severed, the flow of blood tends to be both immediate and copious.

I was injected with a couple of shots of lignocaine to numb the site. To some extent it was successful but, even so, as the needle was slipped beneath the skin in the proximity of the inguinal lymph nodes, I began to experience some degree of discomfort. I tried to grin and bear it, focussing my attention on the meandering geese on the ceiling, but my efforts were doomed to failure as I winced from the pain.

“Would you like some sedative?” asked the concerned Dr. Amersey. An emphatic “Yes” was my reply. As a guy, the general expectation seems to be that one should put up with a degree of discomfort without moaning and, in general, I am pretty OK with that but... one also needs to know one’s limitations! A nurse was instructed to feed some anti-emetic into the cannula, mercifully followed by a dose of diamorphine. The familiar, slightly woozy, feeling flooded through my body quickly followed by the relaxing effect of the drug.

Every now and then I would receive the instruction to ‘relax.’ As you can readily imagine this was, in practice, much easier said than done! The procedure is not the most relaxing process in the first place but having someone slide a needle up through your groin and into your femoral artery would not be the first choice on my list as a way to relax. Still, I did as much as I could and tried to focus my mind on the pastoral scene above my head.

In time, and with a degree of difficulty, the needle was in place and a wire was passed up through the arterial system destined for the vicinity of my heart. I could scarcely make out anything that the doctor was doing as he worked behind a thick perspex screen designed to give him some level of protection from the radiation emitted by the fluoroscope. The surgeon also wears a leaded jacket designed to offer a further level of protection. As a patient you have no such defences but, hopefully at least, one is only exposed to the x-rays for the relatively short amount of time involved in the procedure.

The time came to inject the dye; I was warned that I might feel a little pressure at this point. I looked across to the screens above and to my left. Strange to see the motion of the blood and dye around one’s own arterial system. The images were very clear though, as was the problem that Dr. Amersey pointed out. One artery barely seemed able to allow blood to flow through it at all. He explained that now we were in this position, probably the best thing to do would be to immediately go ahead with an angioplasty. This involves place a stent, a small metal tube, inside the affected artery in order to hold back the atheroma (area where the artery has narrowed) and allow blood to pass through freely once more. He explained that although the procedure had a certain level of risk he believed that in this case it was the only sensible alternative.

I nodded my assent. I will admit I was not overly keen to undergo such a procedure but the alternative seemed even worse. It was explained to me that I would feel some pressure as the stent was put in place. The doctor asked for a length of what appeared to be plastic tubing and a stent of a certain size. Within a couple of minutes the process had started and he delicately, and very skilfully, pushed the stent into the affected artery.

Once again, I was told I may feel some pressure in the chest and, sure enough, within a few seconds, I did. It felt somewhat like having the heart attack all over again, maybe not quite so intense but really quite similar. The doctor and one of the nurses began to count in unison: “Going up, 2,4,6,8,10,” each confirming the other. This count is performed as air is pushed into the balloon that is inside the stent. Inflating the balloon causes the cage-like structure of the stent to expand. Whilst this is occurring though, there is a considerable build up of pressure in the chest. I could feel my temperature going up and was aware of a certain faintness. I was given the chance to rest for a second and then the count started once more: “Going up, 2,4,6,8,10,12…hold at 12.” The pressure was quite high at this point but, finally, it was done. The stent was in place.

There was some discussion taking place between the doctor and a couple of nurses but I could not quite make out what was troubling them. A minute or two later, Dr. Amersey appeared from behind the perspex screen, his expression an odd mixture of satisfaction at a job well done and yet clearly a little concerned at one and the same time. It was one of those “Do you want the good news or the bad news?” moments.

“Well” he announced, “that went very well. The stent is in place and it looks to have settled in well but, unfortunately… ”

I had some idea what was coming but let him continue.

“…as we carried out the procedure, one of the nurses noted a second arterial blockage. With your permission, I would like to go ahead and attempt to put a second stent in place.”

It was an odd moment for me. On the one hand I had thought that the procedure had finished and I had survived relatively intact, there was some sense of relief in this thought and to be told that this was not yet the case was not exactly what I wanted to hear. On the other hand, if there was a second blockage, I should be grateful to the nurse for being so attentive. There was no other sensible choice really, I gave my permission and even thanked the nurse who had noticed the problem.

The second one seemed more intricate than the first. Once more I was warned of the change of pressure, once more I felt this in my chest. The balloon holds back the arterial flow so it is scarcely surprising that pressure would result. For my part, I was just about exhausted at this point. The heart attack had generally left me somewhat weakened and this kind of continuous stress is quite difficult to bear uin that state.

As the pressure built up in my chest I found that I could not bare to look at the screens any more and instead focussed my attention on the red headed nurse standing at the back of the theatre, looking on attentively. In a normal sense, staring in such a way may have been perceived as quite rude but from my point of view consciously and quite deliberately distracting my own attention in those moments really helped.

I heard the now familiar counting in the background, felt the pressure building, was aware that my head was swimming a little and aware of the desire that this should all be over soon. For now, I had had enough.

A few brief minutes later, Dr. Amersey once more appeared from behind the perspex screen. He looked hot, a little flustered even, but elated. He confirmed that the stent was in place and, as far as he could tell, it had all gone as well as could be hoped. I looked across to the clock, nearly two hours had passed, and back to Dr. Amersey. He appeared tired and a little drawn now.

“Are you OK?” I asked.

“Back is aching a little,” he explained, ” these leather jackets weigh you down over time.”

I felt and expressed my gratitude to him. A wave of emotion, relief for the most part, rose up within me. I could scarcely speak. A nurse had to hold a plug in place in the femoral artery for some minutes. This was painful but the pain was of a type that was easier to bear.

I knew the worst was over, for now...