Recovery

Four days and endless nights in the ICU were followed by a couple of days in a regular hospital room.  Lots of tubes went into and out of my body in the beginning, including three drainage tubes inserted directly into my chest.  Multiple IVs went into my arm carrying saline, drugs or liquid nutrition.  I ate only a few bites of solid food during my eight days in the hospital, but still gained 24 pounds from intravenous feeding.  Over the next 10 months, my weight dropped to a low of ten pounds below my 155 pound presurgery weight. 

Pure oxygen flooded directly into my nostrils.  Monitors on my fingers, arms and across my chest sent numbers and flowing lines to readout machines next to my bed 24 hours a day.  A blood pressure cuff tightened automatically around the clock.  Chest X-rays, taken daily at 4:30 am, were my only trip outside the ICU.  My bed was wheeled to the imaging center, marking the blessed end of the night.  Respiratory therapists sat with me several times daily in the ICU as I struggled to inhale a medicine-laden mist for 20 minutes. 

The pain was constant.  Survival without painkillers after open-heart surgery is impossible.  Fortunately, powerful pain killers exist, but pain management is a challenge.  Controlling 90 percent of the pain might leave a patient in agony, but boosting it to 95 percent might leave him or her lethargic and susceptible to pneumonia.  I went through a number of painkillers at multiple doses in my days at the ICU.  Sharp words were exchanged between Cheri and my surgeon.  The pain level ranged from a little better to worse, but rarely reached “good”.

Twice-daily walks around the ICU were a high point.  It took two nurses about 15 minutes to unhook wires and tubes, get me into a standing position so I could hold onto a walker, then reconnect the wires and tubes to a new set of gear piled on an adjacent mobile cart.  One nurse held my arm, a second pushed the equipment cart, I clutched the walker for dear life and off we went.  The rooms in the ICU unit were configured on the outside of an oval around the nursing stations in the core.  As I walked around the oval, each nurse looked up as I passed, smiled broadly and said something like “Looking good.” 

Positive encouragement and a lack of mirrors are the keys to positive outcomes in the ICU.  The walks were thrilling to me.  I became convinced I was doing really well, until I saw myself in a mirror much later.    Another CABG survivor walking on the treadmill next to me in the cardiac rehab center weeks later said he cried when he first saw himself after surgery.  I might have also cried.

John was my night nurse during all four nights in the ICU.  We talked often during the night, like soldiers passing a cigarette back and forth in a foxhole.  I clutched John’s arm each morning to be sure he would be with me again when night came.  But after the fourth night, he said he would not be my nurse anymore.  I was crushed.  My eyes watered and lips quivered.  After a pause, he added that he only treated people very near death.  I was now too healthy for him.  He was convinced that I was going to make it and he left. 

I never saw John again, although I wanted to and promised myself I would.  My struggles in recovery swept over me, carrying me farther and farther away from the ICU into a world which I didn’t function very well in.  As bad as my time in the ICU was, I have never felt so connected to life as I did during my middle of the night conversations with John.

After two more nights in a regular hospital room, I was finally released.  The total multipage hospital bill for my week long stay was $135,000.  I left with a multi-inch thick file of my medical records that accumulated during my stay.  These were delivered by the hospital at my request.  Once home, I noted a report from the heart surgeon correctly noting my diagnosis before the CABG as “coronary artery disease.”  After the surgery, he noted my post-operative diagnosis as “cancer.”    When I called about this, he said his verbal notes must have been transcribed incorrectly and sent me a corrected form eliminating the reference to cancer.  He did, but nine years later when I transferred my care to a new hospital and had my records sent ahead, the official surgeon report diagnosis still says “cancer.”

The five-minute drive home was frightening.  The outside world was intense.  I tried to keep my eyes closed, but had to fight the thrill of seeing what I had once thought I would never see again.  The joy of being home was immense.  I took a fresh dose of painkillers and a handful of the newly prescribed drugs and maneuvered into my own bed, a complicated ballet I had to perform for several weeks without using my arms to avoid pressuring my damaged breast bone. 

After a couple of days, Cheri and I began to relax for the first time.  We sorted out my pills and organized them into morning and night boxes in a two-week pill dispenser.  I peaked at 13 pills a day at a cost of more than $3,000 per year.  I am now taking nine.

Life fell into a pattern of 12 hours on the second floor of our house followed by 12 hours on the ground floor.  My surgeon initially limited stair climbing to once a day.  I left a fiction book alongside my chair on the second floor and a nonfiction book beside the sofa on the first floor so my hands were free to clutch the bannister on the stairs.  Nonfiction or fiction was a main difference between my half days on each floor.  Also, the view from the second floor looked out the front.  From the first floor, it faced the back.

I usually went to bed around 10 pm after taking a sleeping pill and one of my four daily rounds of pain meds.  The combination generally allowed me to sleep for about four hours, at which point the pain overpowered the sedative effect.  I got up and made my trek down the stairs and began reading.

My first downstairs book was “Washington’s Crossing,” a history of the revolutionary war in the months following Washington’s army crossing of the Delaware River to attack the British in New Jersey.  Long before dawn in the dead silence of night reading this book, I made the first discovery that my operation had fundamentally changed me.  I fell completely into the story.  I was shivering in the boat crossing the ice clogged Delaware River.  I could hear the heavy breathing of the marching horses and see the steam of their breath.  I was panicked waiting for the order to launch a surprised attack against the British at Trenton and again up the road at Princeton. 

My emotional involvements reading the book and the hundreds that have followed were far more intense to me than most of my personal interactions in the real world.  Reality, it seems, isn’t the only thing going on, and it’s often not the most interesting.  Another advantage of living through books it that you can reread a page you don’t understand.  The real world moves on, except for the occasional glance back by one of the normal people wondering “what’s wrong with him?”

About a week after returning home, David flew in for a visit.  The three of us ate dinner together the first night.  It was a great thrill for me and I laughed so long and hard that I grew worried that my breastbone would become unhinged.  I love both of them, and I knew clearly that I had made the right choice after my surgery. 

Most of my life was consumed with basic recovery.  In between downing pain killers, I followed a regimen of rest, eating, and physical and mental exercise.  My first walk outdoors took me about 100 feet to the end of the driveway.  I barely made it back with Cheri’s help.  Within a week or two at home, though, I had worked up to a mile on flat surfaces, followed quickly by longer and more frequent hikes.  Small hills were added to my itinerary about week four.  The painkillers stopped after about six weeks.

I enrolled in the cardiac rehab program at the hospital as soon as they would admit me.  My chest was crisscrossed with electrodes and wires while I exercised on the treadmill and stationary bicycle.  I did great on the treadmill, but struggled to pedal for just 15 minutes on a stationary bike.  Before surgery, I had ridden my bicycle most days and had competed in several 100-mile “century” races.  I was an experienced and competent bike enthusiast.  After CABG, however, I couldn’t seem to pedal for even short periods.  I still can’t.

I changed my diet.  Prior to my surgery, I had never met a saturated fat that I didn’t like.  My career had taken me around the world.  When I would arrive after an overnight flight to Frankfurt, I would race to the bratwurst stand for breakfast.  In Spain, I ate roast pig; in China, Peking Duck.  Big red steaks in Argentina; pate in France; bacon cheeseburgers at home.  I won’t even mention desserts.

I have not had one bite of any of these foods since my CABG.  My diet is now mostly vegan, although I eat fish, turkey and rarely chicken.  Beans are my new red meat, hummus my pate, olive oil my new butter.  I eat a bowl of fruit every morning and skip desserts.  I spend more time reading nutrition labels than most people spend reading books.  This transformation was difficult, but if they ever discover a cure for heart disease, I would not return to my previous diet.  I feel much better now.

CABG surgery is like being run over by a bus.  Recovery takes a long time.  My basic recovery took roughly six months.  The good news was that virtually each day was better than the day before.  The bad news was I didn’t make it all the way back.