The Heart Of The Matter

A brief story of a heart by-pass patient

Acid reflux had plagued my life for years, probably the result of heavy drinking in my late teens and early twenties together with a lack of healthy food. Army food was quite nutritious if it looked the opposite sometimes. But I regularly missed mealtimes, preferring to spend my time in bars and clubs where a lot of binge drinking took place.

In the early years of marriage the symptoms remained although by this time I had left the army and my drinking had reduced, so I sought the expertise of specialists and consultants to try to rid me of these constant irritations. I had barium meals, endoscopies and a couple of sessions of investigations where thallium was injected into my veins and x-rays taken to search for the culprit.

Consultants deduced that stress was the cause of my tender tum and I was put on medicine courses to give relief. I gave up taking medicines during the last few years, as they seemed to be doing very little for me and had been relieving the symptoms with small doses of bicarbonate of soda in water. I thought I’d had one of these indigestion attacks one Friday lunchtime. I’d gone home for lunch from work and was on my way back which was only five minutes walk. The pain got worse and began radiating out down my arms and most painfully up into my jaw. I was unable to maintain a steady breathing pattern and began to realise this may be more than just indigestion. I had to pass my G.P’s surgery on the way so called in and explained to the receptionist my painful symptoms. Well, all hell broke out and I was rushed into the practice nurses room, made to chew an aspirin, and immediately found my exposed chest covered in sticky plaster things connected by wires to what I was to become so familiar with in the coming months as an ECG (electro-cardiograph) monitor. Very soon I was on my way to the Royal United Hospital in Bath, along with Jackie my wife, who incidentally worked for the local NHS Primary Care Trust located above the doctors surgery. The paramedics asked me which hospital I would like to go to as I had a choice due to the geographical region of where we live. Retrospectively it would have been more prudent of me to have chosen the Bristol Royal Infirmary, for one of the country’s centres of excellence happens to be there, and incidentally the very place I was to have my eventual surgery.

At the RUH I was ushered into A&E but remained on the ambulance trolley as it was the practice in that hospital, which also meant the paramedics weren’t free to resume their duties until the A&E released them once I was allocated an A&E ward space. Very soon I was again attached to an ECG monitor, and lay waiting to be ‘processed, the formal ‘booking in’. At this time I was still not aware that I had had a bad angina attack.

I was supplied with a ‘line’ an intravenous long, but very fine needle into my arm, which was an access for the introduction of drugs. It’s surprising how pain free modern injections feel nowadays. I spent the next extremely uncomfortable twenty-four hours on the A&E trolley in the assessment unit. There weren’t enough pillows for more than one each due to cutbacks and the bottom sheet kept disappearing over the side all through the night. I was parked up opposite the nurse’s station and could see my name gradually creeping up the list until it was my turn to get a proper bed. In the Medical Assessment Unit, more of a normal ward, I was deposited right next to the toilets, but couldn’t care less as it was pure heaven to climb into a bed that felt like it was almost king size compared to the trolley! It was the policy that all new patients to the MAU remain in bed or sat in a day chair and press the buzzer to be transported by wheelchair to the loo. The only trouble was the buzzer sounder was located right in front of my bed, and I was subjected to a constant buzz, buzz, buzz until I found a lump of Blue-tack and stuck it on the front to mute it. I have until now omitted that I smoked about thirty roll-ups a day and had done so since I could afford to by cigarettes some forty years previously. I was suffering withdrawal symptoms, as I’d not had a single puff for forty-eight hours, but I was the most surprised person in the world when I eventually stopped smoking within the month, and have not had one since. The craving has gone, the urge will probably always be there, but my scarred body and recollections of the operation will be there to remind me why it was paramount that I stop. On the Sunday I felt like a charlatan, for all around me I could see sick people yet was feeling quite healthy. There was nothing I could do because the doctor wasn’t due in until the Monday, but just sat there as bored as one could be. Monday arrived, along with the doctor and his entourage and he suggested I use the treadmill in the hope of gleaning further reasons for the chest pains. I still hadn’t a clue that I had had a heart attack.

On the Tuesday I went for my treadmill test in the cardiac department, which consisted of another wiring up to an ECG monitor and stepping onto a treadmill; the sort you find in any modern gym. I was instructed to walk for as long as I was able, the inclination rising every three minutes. After seven minutes I got bored and the process was halted. During his rounds the following day doctor told me the tests were fine and that I could go home, but report any recurrences to my G.P. I was more than happy, as the following day was my fifty-fifth birthday.

As I have said, I stopped smoking within the month. It was extremely hard, as I had been at it for so long I didn’t know what life was like without a fag in my hand and a tobacco pouch in my hip pocket. I knew reducing or giving up wasn’t going to happen of my own accord, so after discussing it with my G.P, she prescribed nicotine patches. Within days I was down to just one roll-up a day.

Not having been told I had heart disease, life continued much the same, although I think there were times over the next few weeks when I did recall a few ‘twinges’. On the Wednesday before the Easter break I was standing in for a colleague on the early shift and part of the duties was to unlock the town hall offices and I had just done that when another, more harsher angina attack forced me to sit for about fifteen minutes while I regained the strength to carry on. The pain came in the form of an indigestion-type pain, only much more sharper. The feeling is like having trapped air in the upper part of the chest and being unable to shift it, along with the unbearable ache in the lower jaw.

At about one am on the Good Friday morning I awoke with the most severe chest pains, and avoiding wakening my wife made my way downstairs to seek out my GTN spray and had a few squirts under my tongue. GTN (glycerol trinitrate) when sprayed under the tongue should immediately distend blood vessels allowing any restrictions to pass. Now this stuff while giving immediate relief tastes awful and leaves one very light headed and follows up with a nasty headache, but must be one of the worlds best aids to angina sufferers. When I went back to bed Jackie was awake, took one look at me, recognised the symptoms of grey, sweating face and my harsh breathing and immediately phoned for an ambulance. I quickly got dressed and while Jackie was doing so I went downstairs. Within literally five minutes the ambulance was outside, but they only had to travel about four hundred yards because the ambulance station is in our street. I think the paramedics had a bit of a surprise when I opened the door because they asked who the patient was and when I said me they were taken aback a bit. I was soon back in A&E at the Bath hospital. After the now familiar registration process I was transferred to AAU much quicker than before. Perhaps they were getting to know me. Time spent in this unit was rapid, and I found myself back in Medical Assessment in the same day. I was given a bed right next to the kitchen and expected to get little rest. I wasn’t disappointed. Very little happened over the holiday weekend, apart the coming and going of other patients, but on the Tuesday after Easter Monday I got a visit from a consultant and his followers. He explained that I had suffered from ‘unprovoked angina’, which meant I could and indeed did suffer an attack at any time, not just on exertion. He turned to one of his underlings and stated that a cardiologist should see me urgently, and that an outpatient appointment should be made for no later than two weeks from then. I happened to catch the sidelong looks given to each other among the staff around my bedside, but not a word was said. However, I did receive an appointment just sixteen weeks later. I had of course been into seven weeks convalescence after surgery by then.

I went home later that day, hugely apprehensive about how my health might deteriorate over the following months. Jackie booked an appointment with my G.P for the next Thursday in order for me to acquire a sick note for work. On the Thursday I got up and readied myself for the short trip to the surgery and went into the back garden for a breath of fresh air while Jackie got ready. I suddenly got a sharp pain in my chest, the old familiar pain that quickly travelled up into my jaw and down my arms. When I came inside Jackie took one look at me and rang for an ambulance once again. The ambulance arrived in about fifteen minutes, which I thought amazing for this time they came from central Bristol in the morning rush hour. By this time the pain was quite excruciating and the paramedics gave me a couple of squirts of GTN spray, which reduced the discomfort marginally and bundled me into the ambulance.

We were off to hospital in Bath again.

The discomfort in my chest didn’t really subside until I arrived in A&E where the duty Doctor gave me a dose of morphine. The pain died away almost immediately and calmness swept over me. I spent even less time in A&E and was despatched at once to MAU, where I was found a bed in team three again, this time at the far end of the ward but once again opposite the nurses station. I was beginning to wonder if I had an attraction to the noisiest parts of the hospital. I remained in MAU for over a week, then spent a couple of nights in another ward before there became a bed available in the Cardiac Unit.

I settled into the cardiac unit finding the modern, clean and airy ward a welcome change from the ancient other wards. The daily routine seldom changed and started with blinds being thrust aside and accompanied by a hot drink. The wakening calls could be anything up to an hour different according to whoever was on night duty and toward the end of my stay one of the six patients in our small ward would race to get the blinds open before the nurse came in, thus ending her or his sadistic rousing. Medication was usually prescribed by ones consultant and could change from day to day and week by week, higher or lower doses according to the patient’s progress or stability of symptoms. I did enquire as to what the various drugs did and their names, and one nurse even loaned me a gazetteer, which I found useful when it came to analysing side effects and so on.

After sitting around all day watching telly or doing jigsaws it was my turn to go to the Bristol Royal Infirmary for an angiogram, which basically involved a very thin catheter being inserted through the femoral artery, passing it up through the torso to reach the heart. Once there a radioactive dye was introduced to seek out any points of a blockage in arteries around the heart. This operation was completely painless. The radiologist found three blocked arteries.

The preparation for the angiogram was to be woken at five thirty on the morning one went, given some toast and to be allowed to go back to sleep until it became time. On my particular excursion two female patients joined me and we were bundled into the ambulance. On the journey of about thirty minutes a nurse who accompanied the paramedics told us about the whole process so we were put at ease when we got to Bristol. The RUH does not have the facilities to carry out angiograms as there could be the possibility of open-heart surgery having to be performed during the angiogram, but I am told it does not happen very often.

Once the ladies had finished it was my turn and I was wheeled in and took my place on the operation table. T.V monitors hung from the ceiling everywhere I looked and a menacing looking X-ray machine hovered above my head, waiting to carry out its job. There were clear plastic screens all around and I presumed they were there to protect the staff from harmful rays. A local anaesthetic numbed my groin and the doctor was ready to start. He told me to turn my head to the right to see the T.V show, and there in front of me was a picture of the catheter wending its way towards my heart. Once there I could see the dye (Thallium I believe) shooting just like sheet lightning around my arteries. I was fascinated. After about twenty minutes of this the doctor had finished and came to tell me the news. Apparently my arteries were in a right mess and he informed me I was to have three grafts, a triple by-pass operation. I was gobsmacked. I was wheeled back into a recovery area where the nurse who had assisted in the theatre had to stem the blood flow from my femoral artery where the insertion had been. To do this she had to press on the spot for ten minutes and if it didn’t stop she would have had to do it again for ten minutes. Luckily for me it worked first time because the nurse was quite strong and inflicted a lot of pressure. I was soon back at the Cardiac Unit in RUH Bath, my bed curtains drawn shut leaving me to contemplate the forthcoming surgery. Jackie joined me a few hours later and I admit I was a bit weepy as the realisation hit me.

Life settled down again to the regular routine of hospital life, which in the cardiac wards was very quiet. Days of jigsaw puzzles, crosswords, blood tests, scrabble and gossip from home followed. Every weekday an appointed junior doctor came in just to say there was no change in the queue for surgery. Everything became so frustratingly boring, the tedium broken by strolls around the hospital grounds and the few hours allowed at home on Saturdays. Around about now I started suffering slight spells of angina pains, especially in the mornings and just as I settled down to sleep at night, but felt quite calm knowing help was right at hand. Each time it happened and I told the nursing staff, the ECG monitors were quickly set up and recorded to go into my expanding bed notes folder. Of course at these times home visits at weekends were stopped until the doctor cleared me again.

My name crept ever higher on the list for surgery, but it still seemed an agonisingly long way to the top. All the patients who were there when I arrived on the ward had either gone for surgery or had gone home and I began to withdraw into my own little world. It was around this time that the hospital became local news when the Chief Executive was suspended. Television crews camped in the grounds outside and when the subject went live during the news programme it was strange to see oneself peering from the ward window on our ward television sets. My wife Jackie, like most people nationwide began to become highly discerned with the way the government had lapsed in its promises to reduce hospital waiting times for both in- and out-patients. Her frustrations were manifested when she wrote to our M.P questioning why so many patients were ‘bed-blocking’. Her theory being that if there were sufficient cardiologists with the experience of heart surgery to be able to perform in most hospitals, those patients sat in beds for months on end would decrease. Jackie received a reply and also one from the new Chief Executive at RUH. Both agreed in a round about way with her, as is the way with politicians and those they control. Whether this had any significant involvement with my case I don’t know, but one afternoon just days later I was told by the ward sister to pack my bags as I was off to the Bristol Royal Infirmary, my name had reached the top of the list. Hospital experience was telling me not to hurry, as I would be sat on my bed for hours but sister came back telling me to get a move on as the ambulance was waiting downstairs. All my possessions were now on the bed, a comfy pillow, books, magazines and a secret hoard of sweet things (I had just given up smoking remember). I started to panic as I couldn’t get hold of Jackie on the phone and everything was all over the place. Sister came to my rescue, wrapped everything up in the counterpane and whisked it off to her office to await Jackie who would have to drag it all home, for apart from the basics there was nothing else I needed where I was going.

I was on the move again.

I said all my goodbyes and the paramedic’s trolley whisked me down to reception where I had spent many an hour studying the comings and goings of ambulances, trying to guess where they were headed. Now it was my turn. We were soon out of Bath and headed through the few miles of greenery between there and Bristol. I felt quite homesick as we passed through Keynsham where I live, but it was short lived as we entered the hustle of Bristol for I had other things on my mind. After crawling through the busy suburbs we finally arrived at the BRI, a gaunt, Edwardian monstrosity rising up from the noisy street. I was allocated a bed in a small ward of just four beds, tucked away in the corner, just this side of intensive care. A petite Philipino sister came along to process my registration, and the familiar observations were carried out. Jackie, my son Matt and daughter Joanne arrived as the nurse continued and it was as much as I could do to concentrate on what she was telling me for now it had dawned on me that the time had arrived for surgery, after all that time of waiting. A doctor came in just after to explain briefly what was happening over the next few days. He was Italian and hard to understand, but I got the gist of it. My turn would be second for surgery the following day, and that meant it would take place after lunch. I was to be allowed a light breakfast of cereal or toast but not after 05:30 a.m and that meant being woken up in the middle of the night again. The sister came back and asked my family and I if we would like to visit the intensive care room next door, a way of putting patients and family at ease, she said. We made our way via the ‘back door’. I say the back door because there was an entrance near the foot of my bed to be used by staff and also was the route out from ICU. We entered a scene of subdued lighting and quietness; the loudest sounds came from the alarms on monitoring equipment, gentle beeps which mostly indicated if a patients’ pulse monitor became disengaged, a device attached to a finger. Mine came of constantly when I occupied a bed in here. An elderly patient lay in the bed nearest the nurse’s station and it gave me a start to see his ashen colour and a long strip of gauze covering his chest. A myriad of pipes tubes and wires extended from different parts of his body leading off in all directions. Sister explained that the man had had surgery that morning, and that it was expected that I might resemble his state following my procedure, a very sobering thought. Once my family had left I settled down to the task of my own limited preparation for the next day. I was instructed to shave all the hair from my chest as far as my navel, to shave my left arm and my left leg the entire length. I was to realise later why the nurses insisted that the whole leg be hair free. Sleep didn’t come so very easy as one would expect, and it seemed that I had just dropped off when I was woken up for breakfast at five a.m. The condemned man ate a HEARTY(?) breakfast.

I was prepared for theatre during that morning, given sedatives and told to just relax. Jackie, Matt and Jo were at my bedside and we exchanged nervous, light-hearted banter until Sister came in and told my family that they were disturbing the effects of the sedatives and asked them to leave. I remember signing a consent form and being wheeled into the theatre around lunchtime, but that’s all I did remember for a couple of days.

When I did eventually regain any sense of consciousness my brain seemed to be functioning at quarter speed. My vision was extremely poor, and I could just make out the outline of a person in the bed opposite. It was a strange world indeed with half-dream following half-hallucination making up most of my day and night. Sounds appeared to come from a long way off didn’t correspond with the actions of the nursing staff tending the patients around the ICU. Each patient had a dedicated nurse in the ICU and mine hovered somewhere to the rear of my bed. A voice constantly asked if I was comfortable, and if I was in pain I was to give the button a push on the end of a cable laid to hand which would administer a small dose of morphine, calculated to only give a measured amount over an hour, but I invariably forgot to press it. I really didn’t feel too much discomfort in the early days but I suppose that was put down to the twilight world I existed in. I do recall the tubes that felt like hose pipes thrust down my throat, and felt so much better when they were removed shortly after regaining my senses. During the first hours into recovery my condition was borderline I was later informed. What was supposed to be a straightforward (which never is in heart surgery) triple by-pass operation turned into a quadruple when it was discovered that my heart wasn’t working. I had another blocked artery and it had to be bypassed fast. Another vein was removed from my leg which finished with a wound running from my left ankle to well above the knee I was still losing blood and the surgeon was on standby to go back in to stem it. Fortunately the seepage ceased and I was slowly on the mend.

After two days I was transferred to the High Dependency ward and the process of removing stitches and pipes began. My reflexes were still slow and it took me ages to move any part of my body. This was to last for several days. The first of the drainpipes to be removed was the bladder catheter. It was the first time I had had one and just after I came round after the op I kept asking for water which my nurse obliged me with. After sucking what I thought was gallons through a straw I mentioned to my nurse that I might soon require a bed bottle. You don’t need one was the reply and at this I had a grope around and discovered why. The next drains to be taken out were from my chest, which had been put in just under the incision to get to the heart. These were three pipes about the thickness of a pencil and were carrying post-op liquids from the chest into a bottle under my bed. Two nurses were needed to carry out this task they explained as they approached me; one to pull out the pipes one at a time whilst the other pulled tight the sutures so as to prevent leakage. They must have noticed the shocked look on my face as the first one came out as the bit inside must have measured a good foot long. Two more followed without a fuss and I never felt the slightest discomfort throughout. My eyes were still giving me problems; I could only see things in an out-of-focus haze and to accompany it my co-ordination was shot away. Nurse got out my shaving kit suggesting I shave myself. I took the challenge but knew from the outset it wasn’t going to be that easy as I had to change the blade and it was one of those razors with a changeable blade cassette where the blade just clicks into the handle. I managed that bit alright but began to doubt my prowess when I couldn’t see whether the blade was pointing towards or away from my skin. Now I have been shaving for over forty years but there was no way I was going to try it out by just putting the razor next to my face. I called the nurse over and tried to explain that I needed her to look at the blade for me. She must have taken me for a baby or complete idiot, grabbed the razor and promptly gave me the closest, expert shave I think I have ever had, and the first time by somebody else.

I spent the rest of that week watching the football world cup on the telly, the times between were being attended by the nursing staff who changed my dressings several times a day as I had a little weeping from the wounds which was quite common in the early days post surgery. I had a wound on my left forearm, which stretched from the inside of my wrist to the crux of my elbow. My chest one was from where the collarbones meet downward for about eight inches, finishing with the three small horizontal scars where the drains had entered. I recall only slight pain from these wounds, the arm one a bit more because in the early days it looked as if it had been hacked open to retrieve the veins with a can opener. Imagine my surprise when watching a T.V programme recently that the incision is made with a pair of scissors. The other graft originated from a mammary artery found in the chest which I am informed makes a better graft anyway because it lasts longer than veins.

I was due to be discharged from the Bristol Royal Infirmary on the Friday, one week after my op but was ill that morning. I had gone for a wash and shave that morning as usual but suddenly nausea overcame me and I began vomiting for what seemed like an hour. I was only worried about what the retching action would do to my chest wound which I kept protected with the prescribed rolled up towel one carried everywhere . This form of protection was great when one wanted to cough, a practice encouraged by the nursing staff to remove the days of phlegm build up in the bronchial. Deep breathing was paramount in re-inflating the lower lung area, which had had to be pushed out of the way for the surgeon to get to the heart. Anyway, Sister gave me some anti-nausea tablets and I recovered quickly, but the doctor suggested I remain in hospital for one more day just in case. Physiotherapists arrived on the scene and told me I had to perform a little exercise to make sure I could cope at home. They took me to a long flight of stairs which we descended cautiously, came back slowly and without any problems. They issued me with a booklet written by cardiac nurses which I found very useful over the following months on the road to recovery. The next day I was discharged. I was very eager to return home, firstly because Bristol Shoguns were playing rugby and I wanted to see it on T.V in the comfort of my own home and secondly I was about fed up with hospital life: after all it was early June and I had been in and out of hospitals since January.

Matt brought his car to ferry me home and by early afternoon we were on our way. I still clutched the rolled-up to my chest mainly to protect my wound from the chafing seatbelt. In fact the roll stayed with me all the time over the next month there to take the absorption if I were to cough or worse sneeze. It lay beside me in bed too during this time. Bedtime became the worst times in the early days for I have never been able to fall asleep laid on my back, but for the first weeks back in my own bed it was a case of having to, as it was near impossible to turn on any side without extreme discomfort and some pain. It would take Jackie several attempts to prop me in the easiest position which happened to be almost sitting up, and but for painkillers I would have lain awake for hours.

I took short walks over the next few weeks; just really short strolls around the block at snails pace and was soon tired out. On my initial visit to my G.P I asked why I felt so tired all of the time and she put it down to anaemia, prescribed iron tablets and suggested plenty of red meat and all things dietary to aid recovery of a good blood supply. After two weeks Jackie had to return to work again so Joanne, who was still living at home, then became my nurse, did it for a week and then Mother-in-law stayed around for a week. After this time I was well enough to venture out on my own for unaccompanied walks which took me a bit farther each day. I now had time to reflect on the last five months and I admit getting a bit emotional just thinking what would have happened if I hadn’t received the life-saving surgery; how naïve I must have been, thinking I was suffering from bad attacks of indigestion. Now I understood what my poor mother had gone through before her massive, fatal heart attack. I returned to full-time work again at the beginning of that October, and have since been promoted to a middle management position.

My utmost thanks go out to the whole realm of NHS staff who helped me through those traumatic times; first was Dr Hutter who performed the op, then there were the Paramedics, my G.P and all the staff at RUH including nursing, auxiliary, cleaning and the Doctors. Also the brilliant staff at Bristol Royal Infirmary. I cannot leave out the Cardiac Rehab staff at RUH who helped put me back on the road to fitness again. Special thanks also to the British Heart Foundation for the rehab equipment and very informative booklets.

Most important of all the devotion lashed on me by Jackie during this whole time and beyond has been more than I can ever express enough. There were times when she really had her hands full with other family crises as if my troubles weren’t enough.

Jeff Whatley Keynsham, April 2005

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The Heart Of The Matter

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