you may or may not find this fascinating, but i am just now getting all the scabbing off of the main incisions for my surgery. the slowest healing areas are where the chest and stomach tubes went.
i have been using some salves in those areas, and the middle chest tube scar is just now sloughing its scabs. do you know what i found?
you'll get a kick out of this, i think.
as the scab lifted away, i noticed lying just below it, an orange tube, which i took to be surgical threads of some sort. well, i got my little tweezers, and very gently nudged this orange thing, and much to my amazement, it came out of my chest about 3/8" of an inch, in nice tight elliptical coils. no blood, no pain, really absolutely no feeling of tension or adhesion. well, what to do? well, i just took it out the rest of the way & removed it, and it appears for all the world just like a piece of mono-filament fly line, only orange. it was encapsulated in its own little smooth walled hole, directly into my chest, and when unraveled, it is about 3/4" long. the little hole into my chest is about a 1/16" of an inch in diameter.
this happened last night. i woke up this morning, no bleeding, no guts squeezing out the hole. nor harm, no foul, i guess. i have saved it, for a souvenir.
i guess it just sort got left behind when the chest tube came out. i haven't the foggiest notion what its function was. i can tell you, it was most startling when it popped out of my chest like that. laughing.
this day, a subject near and dear to my heart. my heart.
june 1, 2009 i underwent a coronary artery bypass and graft operation, known to the medical types as a “cabbage,” and to the rest of us as open heart surgery. the surgery was necessitated by chest pains the surgeon later described as a “mild” heart attack, whatever that is.
i presented to st. mary’s hospital walla walla, washington with chest pains several days earlier, and angiogram was performed pretty much immediately, and the chest man said we have to transfer you to kadlec hospital in richland, washington and it looks to me like you’ll have to have four bypasses. in richland, the chest cutter told me that he wasn’t tied to the other doc’s estimate, and we would see.
it was four.
i won’t bore you with all the details. i intend to bore you with just some of the details, in the interests of brevity.
there is not much to relate about the pre-op, except the fellow who had a giant syringe with a very large needle, and when i asked him, what are you going to do with that, he laughed and said, you really don’t want to know. some pleasant banter followed, a few laughs were had by all, (this comes, of course, under the heading of “gallows” humor), and lights out.
i want to tell you about lights on.
when you have open heart surgery, they cut your chest open through your breast bone, or, more precisely, the ribs adjacent, pry it open, and lay bare the heart and the lungs. the heart is stopped, and the lungs lie deflated, and you live off of a wonderful machine that oxygenates your blood, extracts the waste gas, and pumps the blood throughout your body. they repair the vasculature of your heart with a large blood vein excised from your leg, and they take it from the crotch to the ankle: in my case, this presented little problem, as they used a spiral cutter which obviated the need to cut the entire leg open.
and then they wire you shut, and then they start you up. sort of like the frankenstein movies in a way, except they just use ordinary electric sockets instead of relying on the stray lightning bolt.
but the effect is about the same.
i don’t know how they do it, and i really don’t care. but, i am going to tell you, as best my poor powers allow, what it is like.—
from out of the darkness you become vaguely aware of people encouraging you, much like a yell squad as you play on a court, and it is like being in the bottom of a very deep and dark well shaft, and hearing a faint noise and seeing a faint light at the top as the rescuers rush against your desire just to give up.
they want you to breathe.
you want to scream, as the pain penetrates even your sedation, and it is excruciating, like nothing i had ever experienced before. but, i could not scream, or at least i don’t think i could, because there is no air in my lungs. but, even so, i struggle to scream and even as zonked as i am, i know that it is not working, and i know that it hurts, but so what. so, i take what is my first inspiration, and i am aware that i have done so, and my chest which has just been cleaved asunder and then sewn back together, screams with me, and i want to scream again, but i cannot, because i have so much goop in my lungs.
you may think, as i did before, that those matters & drives associated with procreation (and just practicing the same, to get it right) are strong urges, but i am here to tell you that such matters pale into insignificance against the cough and the yawn reflex.
i cannot breathe. but, i can cough. and, i can yawn.
my first step into the land of the living is a long protracted cough which hacks up goop in my lungs, and i can feel it gurgling in my chest and throat as it makes it way up, and when that clears, i take a deep breath, and then the matter repeats itself for a brief period, but it ceases being terrifying as the first moments on start up. oh, yes, did i mention the pain associated with the bodily convulsions i have just described, after your chest has been laid open, and your ribs bent back into position, and you have been put back together.
and, then, blessedly, lights out for a little bit.
and, then, lights on in the critical care unit. it is night, and there is little light, except for ambient reds and greens, and your world is literally focused upon what you can see of your lower body as you lie on your back, and an attendant nurse flitting about, tending to this or that, and encouraging you to cough. later, i will be given a pillow, which i name lulu, to clutch to your chest when you cough, to hold my chest together. there are no such niceties in this realm, nor were there any such niceties when they started me up.
you do not want to cough, because it hurts like hell. but, you do, and, in my case, i accuse the man who is trying to save my life of giving me stuff to make me cough, because every time he crouches at the end of my bed, i begin coughing seconds later. he demurs.
i cough. it hurts. for four or five days a i am blowing stuff out of my left sinus and nostril that you cannot believe, from coagulated blood to hard dry blood buggers, to this speckled purplish taupe sort of stuff, that approximates the color they paint the big chryslers, and it appears a mixture of blood and puss: nobody at the hospital ever cares to try and clear this, i guess they just assume that you will take care of it on your own.
after a while you begin to notice that your body will inflict no more pain than you can stand without passing out. odd that.
but, i will tell you what the pain level is, in an oblique sort of way.
when they close your chest, they leave occupation forces behind, to make sure the bleeding inside you does not get out of hand. it is pretty simple how they do this: they just put in a drain.
they leave two plastic tubes, perhaps a foot long, stuck up in your chest around your heart and left lung, to drain off fluids and stray blood that may be leaking from little corners and seams and the like, here and there. the tubes are perforated by oblong holes, to facilitate the entry of the various juices, and drain you do, at first very red, then moderating down to a chianti colored, and then to a weak rose tainted fluid.
for the first two days of my recovery, i really was not too aware of the presence of these tubes. there is the matter of sedation of course, but i am sufficiently conscious of my surrounding to talk on the phone, and to walk with the aid of a nurse, all my regalia trailing behind me, i suppose, and to take visitors.
but, i am, oddly enough, not even aware of the tubes’ presence in my chest, and running into my stomach through my abdominal wall. cyborg like, i pay it little mind.
in short, i really don’t notice the pain inflicted by these things, because my body really doesn’t have the resource to comprehend it, or perceive it, or deal with it, such is the pain in my breast bone, and other places.
but, as that pain moderates, and it does, the things like the tubes become “noticeable,” not too bad, but i know tumble to the fact that they are there.
and, then comes the day they pull the tubes.
the physician’s assistant enters my room with a little tool kit, and says, time to take the tubes out. i have heard of this. but, nothing i have ever heard prepares me for what is to transpire. my bed is positioned, and she takes her place at my side, bends over me, and honest to g_d, disappears from view. first comes the middle chest tube, and the sensation is as a person standing on your chest with both feet and pulling rope from your insides. it leaves me gasping for air, but i am not so oblivious to my surroundings not to notice to large clots of blood hanging from the oblong holes at the end of the top, from the top of my chest. i remark on them, but, apparently, they are unremarkable, as the p.a. says nothing in reply.
and, then comes the second tube, out from under my left floating ribs, the ones at the bottom of the rib cage which are not attached to the sternum, the same ones that joe humbert tried to snap in two when he was a senior and i was a freshman in high school wrestling. this is called, appropriately enough, giving someone a “short waist” in wrestling: you would understand if you had ever had it.
the p.a. wrests the tube from my chest, and i yell and grunt in pain, a very deep “argh!” like sound, not a scream but not too far short of it: i thank g_d that i am not shrill, to my everlasting shame in the ward. the pain keeps me doubled for a while, and the p.a. says calmly, here, now, it will stop hurting so badly in just a little bit.
how bad does it hurt. again, i will tell you in an oblique fashion. a couple of days ago i got to thinking of the wire in my abdomen and over my short ribs, which has stitched me up and held me together. and, suddenly is occurs to me, that i was not sewn up while the tubes were in, or they would still be in. and, no other procedure other than just described was associated with those tubes.
the holes for the drains were sewn at the same time the drains came out of them. the removal of the tubes hurt so badly that i did not even feel the sewing of the holes being performed. well, what of it, you say? well, consider if i were to appear at your bed side, and were to run 3 or 4 stitches with a fairly thick steel thread through your abdominal wall, just for shits and giggles. without anesthetic. do you think that perhaps you might notice. and, the holes closed are not just superficial, but through the thick abdominal muscles just below the rib cage, and that muscle, those tissues, must be brought together before they can heal.
the next thing to be pulled from your innards is the pace maker leads affixed to the front of your chest, to leads having remained attached t the heart, in some manner or another. the leads are plastic coated, and about a 16th of an inch in diameter, and enter the chest about mid level on the heart, and to the left of the sternum. they taper down a bit, and then a braided bare wire a 32nd of an inch or so dangles at the end of them. whatever attaches those bare ends to my heart, is still in there: i know, because i kept the leads as souvenirs.
how do they get them out. well, it is with precious little romance. they just pull them out, that’s how. it only hurts a little bit, in comparative terms. it is not even excruciating or anything, more like bothersome by this point.
oddly enough, given the detail exhausted above, the pain is not really the worst part of this whole deal. in fact, it is simply unbearable. like nothing i have ever felt. i would be interested if any women who read this have had both children and a “cabbage,” if they could issue opinions on which hurt worst, the longest.
no, the worst aspect of this whole process is discomfort, prolonged, unceasing, indifferently administered and couple with an exhausting hospital regime that dictates that you will never rest, never feel good, and will always be more than slightly disoriented because of the effect of anesthetic, pain meds and sleep aids.
these are things that might be properly address and rectified, but such is the inertia of medicine that they simply remain unaddressed, and therefore intolerably aggravating, and a horrible sufferance.
and, this brings me to the bed.
it is sort of like a recliner chair that doesn’t quite work right. the mattress is an inflatable baffle, which automatically sense your weight, and inflates or deflates to allow you to sink into the mattress a prescribed number of inches. it is, in short, designed to keep one immobile, perhaps not a bad idea from one perspective given the tubes, i.v.’s, and e.k.g. monitoring leads and patches attached to one. in theory, one is supposed to be able to adjust it, but it is impossible, because you cannot reach the controls, which are placed so that nurses may adjust them. if you want a hint of this delight, go to a store that sells one of those very expensive memory foam mattresses, and lie on it, and then try and climb out of it, only imagining that any time you put torsion of your abdomen or move your shoulders, it is going to hurt like billybejesus. and then, imagine lying in that position for 8 hours through the passage of a night, with nothing to do and no sleep possible.
as a result, you “sleep” flat on your back, in one position, and if you sweat even a little bit, you are affixed to the rubber bladder as though glued. and, because of this, you hurt, and you drift in and out of pain and slumber at odd hours, and your back and shoulders cramp and tire and ache like manner as your wounds. as an interesting little sidelight, to me, at least, is that my beard felt like the hairs were on fire in the roots, and nothing would assuage that, and no amount of complaining brought any attempts at relief. “interesting, you say,” the nurse would say, and do nothing. finally, when able, i simply doused myself with warm water from a hand towel, in an attempt to cool the burning sensation.
one night after taking a “sleeping pill” i wake at about 3.30 a.m., and i do not recognize my surroundings, and i am so befuddled i do not know where i am. somehow, i twist and turn and manage to take off my gown, shed my blankets, and strip all the e.k.g. leads and contact patches, before a nurse arrives, finding me naked but almost asleep, to see my why e.k.g. monitor has gone flat. they leave me as they find me, cross ways in the bed, and it is the only decent night of sleep i get in the whole hospital stay.
i cannot lead this last tidbit go by. one evening, i am trying to sleep, but i have come so far down in the bed that my feet are up against the footboards of the bed, and i am pinioned worse than usual. after no small struggle I click the nurses light. some strange lady comes in, asks me what i need, and i tell her I need to be positioned farther up the bed so that i can put a little rise in it, and maybe get some comfort. she says, you are too big for me to move by myself, let me go get some help.
she comes back with another woman, nurse or aid, i cannot tell. standing on either side of the bed, they each grasp two ends of the small blanket beneath me, lift, count to three, and wing me along the bed and smack my head, hard, full into the metal head board of the bed. i am stunned, because even for a hospital, this is kind of amazing. now, i have a very large i.v. in my juglar, just above the clavicle, and chest tubes and i.v.’s in my arms, and g_d knows what else. they slide me back down the bed, and wait my reactions, and pretty soon they both issue a nervous laugh, sort of like stephan urkle when he says, “did I do that,” and ask me if I am o.k.?
and, then they leave, like leaves driven before a fall wind, and i never see either of them again.
the american heart association says that approximately 450,000 coronary artery bypasses are performed in hospitals and garages and under shade trees every year in this country: i would not expect anyone else’s experience to be a whole lot more pleasant than mine. i do not know how many people do not survive the operation, or their hospital stay, but i just glanced at a british medical journal and it said that 5% of those who have this operation die within a month of same, based on a study of 343 patients. so, that is 5,000 deaths per 100,000 operations, or somewhat in the ballpark of 20,000 deaths a year from coronary artery operations in this country. ( i would think, just as a wild assed guess, that the hospitals loose more people in bed than on the operating table.) oddly enough, i do not hear biden and obama complaining very much about the carnage inflicted upon their fellow citizens by modern science. yes, i know, without the medical science, several hundreds of thousands would die, more probably than not, if they could not undertake this operation. but, i raise the points by way of illustration, of what is deemed acceptable and what is not deemed acceptable.
i do not think my experience atypical. and, i could relate so much more.
michelle obama worked for about a year and a half as an hospital administrator in chicago, before taking up her present “employ.”
it is my understanding that approximately 3 water boarding interrogations of terror suspects took place at gitmo, and no fatalities.
b. hussein obama and joe biden and other birds of similar ilk and foliage want to prosecute george bush and dick cheney for the “torture” inflicted thereby. yet, so far as i am aware, no one has ever been prosecuted for the performance of a legal coronary artery bypass operation, not the surgeons, not the gas passers, not the guy who was putting “cough syrup” in my blood in intensive care, … , just trying to save my scraggily butt from extinction, … , and, most certainly, not michelle obama for being a front for the hospital which inflicted this sort of treatment.
(oh, yes, i agree wholeheartedly, i signed on voluntarily, in order to save my life, and i suspect were it not for the surgery i would be dead even as i now type this. that is true. but, did the fellows at “gitmo” not volunteer for their “treatment,” given their active role in killing americans and attacking the west?)
personally, i hope we capture osama bin laden alive. and that he has heart disease, and maybe a bad gall bladder to boot, and that he needs a “cabbage” job in order to stay alive. i will quite gladly chip in the first $20.00 towards his “cabbage,” and i want to be there when he needs moved in his bed, and to ally his fears when he wakes at 2.30 a.m. under the effects of anesthesia and pain killers and sleep aids: i will set him straight.
let’s see if he could survive it.
and, you know what? nobody would ever be prosecuted, or hectored by joe biden, for inflicting that sort of torture upon osama, …. , because open heart surgery is an accepted risk.
in my humble opinion, the fellows held at gitmo accepted a similar risk and exposure to “torture” when they signed on as murderous religious zealot thugs, and started killing indiscriminately in the name of islam.
of course, what do i know about it.
john jay @ 06.17.2009