The Heart of the Matter: A Chronicle of Heart Bypass Surgery

     In February 2008, I was, as most teachers were at the time, getting geared up for the final push toward student state evaluations in April.  Christmas vacation was a distant memory and the routine of school has already been reestablished.  I had noticed a slight change in my normal morning preparation for the school day.  From where I parked my car at Williams Elementary, it was a fairly distant walk to my class, but having completed the daily trek for over ten years, it was a routine I scarcely thought about as I made my walk.  The difference was, however, I found I was becoming quite winded in my walking journey and was being forced to catch my breath as I walked through our cafeteria.  After sitting for a couple of minutes, I was able to finish my trip to class and get the day started.
    On this particular Thursday, I made my walk to my classroom, but just as I reached for my door handle, I experienced a severe chest pain which startled me.  I made it inside to my desk and sat down, and in a few minutes the pain subsided.   With the logic that only a person in denial can conjure up, I concluded it must have been indigestion.  I made it through the day with no further flare-ups, but the next morning, the same event occurred at practically the same instant as I reached for my door handle.  That gave me cause for alarm, but I kept my concerns to myself.  The next day, Saturday, I decided to wash my two cars in our driveway at home.  I did not make it through the first car ordeal before I had to stop because of the chest discomfort.  I walked inside our home and told Shirley of the events of the last three days, and she immediately demanded I see my doctor.
    I made the appointment for the following Tuesday, and the first thing Doctor Bernick proposed after hearing my experiences was an EKG.  I don’t think I did very well, as he immediately took me into another room for a stress test.  I did not last four minutes before I nearly collapsed with exhaustion.  Needless to say, he immediately scheduled me to see Doctor Salma Challa, a cardiologist who happened to be my mom’s cardiologist years earlier.  A couple of days later he performed a heart catharization, at which time it was determined that I had severe blockage in five places in my coronary arteries.  I was referred to The Methodist Hospital in the Texas Medical Center to  Doctor Mahesh Ramchandani who would perform the surgery.
    All of these preliminaries to surgery occurred in a brief flurry of days, during which I also notified Mel Capelo, my principal at Williams, that I would be out of service for several weeks and there was a need to arrange for a substitute and coordinated lessons plans.  This all occurred in an almost surreal atmosphere;  I was 64 years old and had never had a serious health issue, and I went through the motions of gearing up for a long hospital stint as if I were preparing for someone else.  Our church had prayer for me, but I was so numb with disbelief that I felt like they were praying for another person.
     March 3, 2008, I entered the office of Surgeon Mahesh Ramchandani, whom I soon learned was an Indian, educated in England, and who quickly set our minds at ease with his easy demeanor.  Well, relatively at ease anyway…it’s not every day you visit a heart surgeon whom you know will in a few days have your life in his hands.  He showed us a photo on his wall of his alma mater, Downing College, which apparently is a sub-college of Cambridge University in England.  He asked if our strain of Downings came from England, but I told him the Downing side of my family is Cherokee Indian.  Eventually we settled down to the issue at hand.  He told me that my upcoming surgery had all the inherent risks of heart surgery, but it was a procedure that had been proven effective over time.  He told me I would be having off-pump artery bypass grafting, which meant little to me, but I found out later was the very latest in heart surgery.  As we left his office, I was pleasantly surprised to see the latest issue of “Texas” magazine and note that Dr. Ramchandani had been selected the Surgeon of the Year for the past year.  At least I didn’t have an amateur.
    At 5:00 A.M., March 11, 2008, Shirley and I walked into The Methodist Hospital and proceeded to Pre-Op.   In a matter of minutes I was whisked into a private room where I was readied for surgery…i.e.…I was stripped.  I was covered with a sheet, then a nurse came in and proceeded to shave my legs, arms, and torso.  This was for the monitors, tubes, etc., he explained.  Anyway, it was an electric razor that sounded like a lawn mower as it chewed up my skin.  Immediately afterward, I was rolled into a pre-op room where I met my team of surgeons who would be assisting Dr. Ramchandani.  Each in a professional manner described their function in the operating room and made an attempt to comfort me in that I was in good hands.  By this time I had received an IV in preparation for sedatives, and upon completion of all the preliminaries, I was wheeled down the hall to greet my loved ones en route to the operating room.  It never occurred to me to think that I may never see them again if the surgery went wrong.  God either gave me a sense of peace or I was just too dazed to understand my situation, I don’t know.  I greeted my family and into the operating room I went.  The anesthesiologist told me he was going to give me something “to relax me”….and darkness fell.                                                                                                                                                        
    My next sensation was that I was choking…seriously choking, and someone was hollering, “Mr. Downing! Mr. Downing!  Try to relax! Try to relax!”  So I made a supreme effort to calm myself, and as I concentrated on being calm, I was able to control the choking.  But then as I relaxed, I would lose my concentration and start choking again.  The apparent problem was I still had the breathing device inserted down my throat, and it gave the same sensation as your sticking your finger down your throat; you have an involuntary reflex to reject it.  All this time someone was holding my hand, and in time said to me, “Mr. Downing, do you think you could breathe easier if we removed the breathing device?  Squeeze my hand if you think yes.”  I crushed his hand!  In a matter of seconds, the device came out of my throat, and I began to ease.  I still had a hyper-sore throat, but at least I wasn’t choking.  Still heavily sedated, I was wheeled into recovery.  I remember asking someone for a little water.  “Later,” she said.
     When I began to regain some semblance of consciousness, I first heard the sounds of nurses apparently talking to other patients and the shuffling and quiet clatter of moving carts and shifting trays.  A few minutes later, my guardian angel, apparently a nurse assigned to me, greeted me with a “Well, you’re finally awake!” and a smile.  She proceeded to check all the gadgets attached to me, and I began to realize that I had more wires and tubes running to me than your average small engine.  According to her, however, I was doing very well, but I was shocked when I asked her the time….it was after 8:00 P.M.  I had been in surgery over ten hours.  The anticipated surgery time had been three-four hours, but there had been a problem with my losing blood, and I had been kept in surgery until the blood loss could be halted.  By 8:00 P.M., however, I had stabilized and hence my location in the post-op intensive care unit.  By now I was becoming more aware of my surroundings and saw that Post-Op ICU held about ten patients with a corresponding number of nurses to monitor the situations.  The most notable event of Post-Op was when a bevy of doctors came in.  One was obviously the leader and the others, I would assume, interns.  They stopped at the bed next to me and the leader said, “This gentleman has had quintuple bypass procedures…that what forty years of smoking will do for you.”  I thought to myself: Now wait…I haven’t smoked a day in my life, and that patient and I have had the same procedures.  What gives?
    Anyway, sometime in the evening, my beloved family was allowed to come visit me, which lifted my spirits, and preparations began to be made to put me in a private room.  Once those arrangements were made, it was time to unplug me from some of the hardware I was hooked up to….plus two others I wasn’t even aware of.  Apparently I had a “port,” which is an intravenous device inserted in my jugular at my throat to allow for fast injections of medication.  My nurse said sometimes when that thing is removed there is a lot of blood due to one’s blood pressure.  She pulled that thing out and slapped her fingers around my throat to compress the incision, and I thought she was going to choke me to death.  She held her hand there for what seemed like an hour but was probably two or three minutes.  No blood though, and all was well.  Next, I found out I had a large tube inserted in my abdomen to allow for internal drainage which had to come out.  She said, “Take a deep breath,” and began to pull.  Weird sensation…like someone had attached a vacuum cleaner to your belly button, except it went inside.  Not painful…just….uncomfortable.   But in a few seconds, it was out, and we went through the hand compression routine again to alleviate any blood loss.  All went well again.  I was ready to roll out of there!
     Around the stroke of midnight I was wheeled into a private room to settle in for the night.  By this time Shirley had joined me for the duration and (I think) the kids and loved ones had gone home, probably exhausted.  Strangely enough, I was feeling pretty well and had yet to feel any pain or discomfort.  Within an hour or so, however, the labors of the day began to take hold, and after the nurses had busied themselves with all their detail, I drifted off to sleep…only to be seemingly instantly awakened at 4:00 A.M.  Apparently every day at that ridiculous hour, every patient in the Methodist system is awakened to have vital signs taken and weighed…which means being rousted out of a peaceful sleep and standing up at the edge of the bed on a scale to get your exact weight.  There’s logic there somewhere, I guess.  Anyway, I drifted back to sleep, and of course, in three more hours it was time for breakfast. 
     The first day post-op was a bit of a blur in the sense that I was sleeping a lot with brief but frequent interruptions by doctors, nurses, aides, custodians, visitors (welcomed), and family.  My one dependable constant, however, was I had only to say, “Honey?” and Shirley was at my bedside awaiting my need.  I quickly learned that even in a darkened room I could look over to the dim outline of a couch and see her curled up there, and it gave me great comfort.  The entire time I was in the hospital, she never left the room, and I am forever thankful.  I rested well, and looked forward to mealtimes.  The prognosis seemed good, and I still had not experiences any pain, for which I was thankful.  I learned the reason for the lack of pain was an epidural injection that was placed in my back.  It administered a low dosage of pain med on a somewhat regular basis, and I could even push a button and receive more if I became uncomfortable.  I never did have the need.
    By Friday, March 14, I was feeling well enough for a therapist to come by and walk me around the hallways for a little exercise, and I had been disconnected from some of all the tubes and wired to which I had been attached.  In fact, I was feeling well enough that I was think about home and a hospital discharge, but that afternoon, my happy bubble burst.  The doctors came by for a visit and expressed satisfaction with my progress, and then announced it was time to remove the epidural in my back and see what level of pain I may experience.  I wasn’t too concerned because I had felt so good up until that time, so out came the epidural and my umbilical cord to a pain-free life.  That evening, my comfort level began to drastically change.
    The first thing I noticed was when I lay quietly I could hear my heartbeat clearly.  You wouldn’t think that would be distracting, but I found myself listening to the rhythm, and it seemed to me that after about every ten beats, it would sort of skip or jump a beat.  I mentioned that ability to hear my heartbeat to a nurse, and she explained that due to the freer flowing of the blood through the heart after surgery, many patients experienced that phenomenon, but it would eventually dissipate.  At the same time I was beginning to feel a creeping sensation of pain in my chest that seemed to increase with each hour.  By the late evening I was most uncomfortable, and the nurse brought in a new pain medication to give me some respite.  I had a very restless night, as the medication didn’t seem to help very much.
    Since I was recovering from heart surgery, I had been attached to a heart monitor, the data from which was transmitted to the nurse’s station so they could constantly monitor my progress.  On Saturday morning the nurse announced that my heart had been acting erratically since around 4:00 A.M.   That was not news to me, since I had been lying there counting the beats and listening with a measure of alarm each time I didn’t hear a beat when there should have been one.  Anxiety breeds more anxiety which seemed to increase my chest pain.  It was decided that a different pain med would be administered since the first one was ineffective.  About the same time, another event took place that let me later realize just how poorly I was feeling.  A nurse came into my room and announced it was time for me to have a bath, and told me another nurse would come in and help me with my sponge bath in the bathroom.  She unhooked me from all my monitors, tubes, etc., and asked me to wait for the bath nurse.  A few minutes later in walked this young, very attractive nurse who announced she was there to give me a bath.  Like a docile lamb, I shuffled to the bathroom, took off my gown, and sat on the toilet, while she gave me an all-over sponge bath…and all the while, all I could think about was how good the warm soap and water felt.  She was most professional, and treated me like a mother bathing her child.  I felt no embarrassment or unease; I just enjoyed the cleansing water.  I must have been really sick.
    That Saturday was one of the more painful days of my life.  With the nurses seemingly unable to find the right combination of pain meds to alleviate my discomfort, I could only lie there and groan.  On top of this, the pain meds begin to affect me in other ways.  I began to hallucinate, although it seemed real at the time and funny now.  Here’s an example:  The nurses’ station was outside my door and to the right maybe 25 feet.  The station was not visible from my bed because of my closet, bathroom, TV, etc.  However (I’m not making this up), when I stared at the wall and squinted my eyes, a hole would appear in the wall, and I could see the nurses working at their station.  Looking back, this probably occurred the time the nurse brought in a container of pain med for my IV that was supposed to be dispensed over a period of hours, and somehow I received the whole bottle in a matter of minutes.  I began to have involuntary muscle contraction, tremors, and extreme shaking.  When the nurse realized what happened, she ran outside and there was a conference as to what to do, but the deed had been done.  They thought I was having hard chills and threw all sorts of blankets on me, but I wasn’t cold, I just couldn’t lie still. At the height of the problem, the event occurred which I described in my blog “Is Healing Overrated?”  Shirley called Kimberly over to the bed and said, “Let’s pray.”  They began to pray, and as they were praying I took a couple of deep breaths, quit shaking, and fell asleep.  I do believe in God’s touch.
    Early Sunday morning, I roused out of my sleep and took an inventory of my heartbeats.  The arrhythmic pattern was still there, and in the silence of the darkened room, my heart seemed to be pounding.  By now I had garnered a dread of the early morning, post-midnight hours.  In the quietness, listening to an erratic heartbeat, and wondering if I was ever going to get out of that room, I probably endured the lowest point in my recovery.  The pain in my chest had subsided a bit thanks to a better combination of pain meds, but the pain and the arrhythmia gave me little promise of a bright prognosis.  My only comfort during these early hours was that I could turn my head to the right and look at the dim shadow of my wife as she no doubt uncomfortably slept on that hospital sofa.  Just knowing she was there gave me a considerable amount of peace.
    By midday Sunday, my condition began to improve, as the right combination of pain meds had been discovered, and I was able to do my walks with the therapist and entertain a fair number of visitors.  My only problem was my 4:00 A.M. heart arrhythmia was persisting, and my doctors made it clear that I would have to have a full 24 hours of nice, smooth heartbeat before I would be released to go home.  Well, that increased the tension, because for the next few days, I invariably awoke at 4:00 A.M. and started listening to my heartbeat.  Sure enough, I would note a skip or feel a flutter in my chest and I knew I was condemned to another day in the hospital.  The early morning report on my nurses’ station heart monitor would confirm my suspicions.  That was enough to depress me for the day.  By Monday, my chest pain was pretty well under control, and I was feeling fairly strong.  I was doing physical therapy by walking around the hallways a couple of times per day, and I was getting increasingly anxious to go home.
    About this time, the nurse replaced my bandages on my chest, and I was amazed to see that I had no stitches or staples.  I can remember when Dad Creel had his heart surgery in 1975 he came home with staples in his chest the size of box staples, but I was astounded to learn that I had been glued together!  Underneath the skin, the breastbone was wired together, but the surface skin looked just like someone had laid down a bead of silicone glue and glued the two sides together.  The nurse said the glue would wash off in a few days and that would be it.  Thank God for modern medicine.
    Wednesday night I experiences my first arrhythmic-free night, and it was announced that if I made in through Thursday night, I could go home Friday.  I sent up a few fervent prayers, and avoided exerting myself in any way, and sailed through Thursday night without a hitch.  Friday morning, May 21, 2008, I was given my discharge and release papers, and packed up, ready for the checkout.  That’s when I found out no one was in a hurry for me to leave except my family, because I didn’t get wheeled down to patient pickup until after 6:00 P.M.  Didn’t matter, I was going home.  Bobby and Shanna were there to drive us, and when we rolled into 405 West Archer, the old home never looked more beautiful.  If I had been able to, I would have gotten out and kissed the ground.
    Saturday was spent just enjoying being home and making adjustments for my recovery.  I found that our regular bed was too flat for me to lay there for an extended time, and a “zero gravity” reclining lawn chair was placed in the bedroom for me to try.  I could adjust the angle of reclining and balance my position.  For the next few weeks, I alternated sleeping in my bed and then switching to the lawn chair every few hours during the night.  I’ve always been pretty restless at night anyway, and the different positions for sleeping helped a great deal.  I was able to re-appreciate sitting on our rear deck, feeling the fresh air and seeing something besides hospital walls…and just being home.  Sunday I still wasn’t strong enough to go to church, so it was a repeat of Saturday.  The kids visited, and things almost seemed back to normal…except I wasn’t very active.  At least I was home, and feeling pretty comfortable with minimal pain.  The only thing I noticed I seemed to be short of breath.  I did not have to take very many steps before I seemed to become very winded and had to sit down, but I attributed the problem to standard recovery from heart surgery.
    By Monday morning, however, my breathing problem was becoming more acute.  Since I had no other symptoms, I tried to ignore it, but as the day wore on, I reached the point that even standing for 15 seconds brought a struggle for breath.  Finally I asked Shirley to call Doctor Challa and describe the problem.  His nurse made an appointment for me for the next day, but by the early afternoon, I told Shirley I didn’t think I could make it till the next day.  She called Dr. Challa’s office, and we were told to come in immediately.  While Shirley changed clothes, I decided I needed to take a quick shower before we left, but I knew I would need to hurry because of my lack of breath.  I ran for the bathroom, dropped my clothes, jumped in the shower, grabbed a bar of soap, and……that’s all I remember.
    I was not aware of what happened in the next few minutes because I was unconscious.  Somehow Shirley pulled me out of the shower and determined I had gone into respiratory arrest.  She called 911 and began to administer CPR.  Apparently I had no heartbeat or pulse for several minutes.  The paramedics arrived and began to do their life saving work, and a pulse was reestablished.  How they got me on that gurney in that narrow hallway I’ll never know, but apparently I was rolled out our front door, down the side walk, and out our driveway to the ambulance.  Sometime on the way to the hospital, I regained consciousness and became aware of feeling sort of a cool breeze.  I learned paramedics do not take time to dress the patient in such emergencies. At the same time, I realized I knew one of the paramedics.  I guess he wanted to relax me for the trip because, in reference to my coming out of the shower, he told me, “Well, Brother Downing, at least you were dressed for the trip!”  They had easy access, anyway.
     I was rushed into San Jacinto Methodist Emergency and after a quick analysis and x-ray it was determined that a large amount of fluid had built up around my heart to the point that the fluid had compressed my lungs to a quarter of their normal size.  The fluid needed to be removed immediately, so I was sat up on the side of the gurney in preparation for a large needle to be inserted into the chest cavity from the back.  I still had no clothes, and although I was still groggy from the shock, I asked for a blanket or some kind of covering.  By then I had been given a sedative, and an area of my back was anesthetized in preparation for the needle.  The doctor said, “You may feel this,” which is never a good omen, but due to the sedatives or shock, I can’t remember any of it.  To make a long story short, 3.9 liters of fluid were removed from my chest….that's just a little over a gallon.  But I was able to breath.
    Once the immediate crisis was over, I was admitted to San Jacinto for observation to make sure the situation did not reoccur.  For the next couple of days there was a constant repeat of EKGs, x-rays, and blood tests.  I was having a little chest discomfort, so I was administered some kind of pain sedative that affected me like the pain sedative at Methodist Downtown.  This time I could not see through walls, but I could conjure up my lap top computer anytime I wanted by just staring straight at the ceiling.  My laptop would float by, and I found I could push the keys by just looking at each key.  I stared at the “r,” then “o,”, then “b,” then “e,” and all the other letters until I signed on and I could access the internet!  People kept coming in and stacking boxes in my hospital room, and I would ask Shirley about the boxes.  She would say that there weren’t any boxes, and I would get out of bed to show her, and as soon as my feet touched the floor, they would all disappear. I could fly, too, but I’m not sure where I was.  It wasn’t the hospital, but I could zip through a wall like it wasn’t there.  I wish they sold that stuff over the counter.
     By Thursday, March 27, my condition had stabilized and no more fluid seemed to be accumulating.  I spent a restful next two days, and on Saturday, March 29, I went home from a hospital for the second time.  Thankfully, from that day on I have had no more heart/chest problems.  The next three months were spent regaining my strength.  I was able, thankfully, in the latter part of May to go back to school and close out the school year.  I had only one challenge for the future: My doctor wanted to do a few more lab tests of my blood to try to determine why the surgeons had such a difficult time stopping my bleeding during my heart surgery.  I was scheduled to visit an oncologist in the latter part of July.   But that’s another story.