sciatica + cortisone injection + blood thinner = NOOOOOO

It all ends well because here's the espresso and blood orange crème glacée I had yesterday afternoon after a very slow walk to the Atwater market. If it ends with ice cream, it can't be that tragic.

About two weeks ago an ongoing flirtation I have with sciatica became so severe that I was almost crippled. Couldn't stand, couldn't sit, couldn't lie down. Over-the-counter relief that I can take with my blood thinner and that doesn't give me nausea wasn't even touching the pain. It had to be bad because I finally went to ER (which I will not do unless I feel I'm close to death).




There I was assessed by a doctor who didn't listen. I told him I had mechanical heart valves. I told him I take blood thinners. I need to take them for the valves to function correctly. Without blood thinners, blood will clot around the valves. Blood thinners are a fact of my life. I didn't think I needed to scream that at him. Even busy and efficient as he was, it should have registered because I asked if he would order a certain blood test that is only done to test the level of anticoagulation, thereby saving me a trip to have it done the next day as I was supposed to. (There are some other details that played a role--I had just had a test and was still being bridged with Fragmin, another anticoagulant--but I told him that too. I did.) He was focused on solving the sciatica/pain problem and gave me a cortisone injection in my hip. I didn't see how long the needle was because I was on my side and in such pain that he could have taken a Japanese sword to me. R who was watching said the needle was 5". Even given spousal anxiety and exaggeration, it was probably long. 

He told me that it would take a few days for the cortisone to take full effect. The pain certainly didn't diminish the first two or three days. Nor did I look at the painful area. It was hard enough just to pull down my pants to use the toilet. I couldn't put my socks on. I was tossing my underpants at my foot like that ring on a peg game. I did notice bruising spreading down my thigh and then swelling but I wasn't sure if that was expected. If you're on a blood thinner, you tend to bruise more than most people do. It was only when R helped undress me in the evening that he said my affected buttock was purple. It seemed to me it was significantly ballooned too. I tried to reach a doctor but was not successful. Message on the answering machine never returned. (That's being looked into.) I did not want to return to ER.

Three days later in the morning I could no longer ignore that my knee was swollen and wow! What coloration! I called my ex-boss at the hospital who said to call my cardiologist who told me to get to ER where I was seen very quickly.

I had bled into my leg. Not just subcutaneously but into the muscle. My hemoglobin was still dropping. My blood thinners had to be stopped. I was given a snazzy medication--Beriplex--that reverses a week's worth of Warfarin in 15 minutes. That, however, left me with no blood thinners to protect my heart valves. There's a window of time that that's safe, though as the window gets smaller, the risk increases. I wasn't happy about that.

The one unexpected and pleasant development was that I was hospitalized in the spanking new K pavilion (at the Jewish General) where my old colleagues from my days as a unit coordinator now work. I saw many old friends and re-found the rich backdrop of sound that I hadn't even realized I missed.

I would sit in my room and listen to the layered mix of Carib English, laughter, Arabic, teeth sucking, doctors discussing cases, Quebecois French (or accented English), machines beeping, argumentative--but not arguing--Creole, carts wheeling by, prayer from a patient's room... 


The food improved once I spoke to the dietician about getting fresh fruit and yogurt and preferably vegetarian.

My friend who thought I'd be lonesome for my backyard where, as I kept lamenting, the squirrels were beheading my tulips sent me a bouquet of beheaded tulips. As the note said: If you have crazy friends, then you have all you need.








In with the grab bag of good and bad that life throws, I was reading the French translation of my novel Five Roses which I love! I have a hard time reading my own work once it's in print because I continue to see things I'd like to improve. Reading the novel in French gave me the distance to appreciate it differently. I am so very happy! AND I got the news that I received a grant from the Conseil des arts et lettres du Québec toward the writing of my next novel!

But there I still was in the hospital, albeit in a gilt cage--large, lovely room with en suite bathroom and shower and huge windows onto the sunset--hoping not to have a stroke. Am I being melodramatic? Maybe. But even a small percentage of risk is a risk I shouldn't have had to take.

There was some concern that starting anti-coagulation might start the bleeding again, so that was done conservatively. Small injections to start with. Yesterday I was able to come home again. The swelling had gone down but I'm going to have a bruise for months I'm told. And although I no longer have severe sciatica pain, I do still have pain and will be seeing a physiotherapist.

I don't want to write about the chat I had with the doctor who administered the cortisone. Though I will observe that his quick, cost-efficient assessment and processing of the patient cost the hospital seven days of hospitalization, specialists' visits, nursing care, CT scans--not to mention the week I had to spend there. Sure, it could have been worse but it also didn't have to happen.

I came home and walked very slowly to the community garden Pointe-Verte where everyone else's gardens have tiny plants and stakes in place and my plot is a mess of baby maple trees, but it hurts too much for me to stay bent or to do anything just yet. I sat in one of the Adirondack chairs under the trees and had a snooze.

And an ice cream.

Then followed this gent in argyle socks across the bridge back to the Pointe and home. While I was in the hospital, the leaves came out and spring finally happened.

happy birthday heart valves

A romantic soap stone heart and an organically correct tin heart. I also have an embroidered heart, a heart pillow, cards with hearts. Memories of visits in the hospital--a couple from friends who had deep-seated personal experiences that made them loathe to step into hospital, and yet they made their way to the ICU while I was still bloated with anaesthetic, for which I will always be grateful. I have a particular paranoia about lying unseen and untouched while unconscious, and I don't want R to have to deal with that alone. I told my friends and they came.





Six years ago today my ribs were sawed open--sure, I asked to see the saw--and my heart was stopped and attached to a pump so that two artificial valves could replace my valves that were no longer functional because they were thick with rheumatic scar tissue.

I wasn't afraid of the surgery but I was existentially FREAKED OUT about having my heart stopped. Would I still be the same person? Was my "soul" going to be altered? Rationally, these were all silly questions. I don't believe in souls per se. But... my heart! I must have studied too much medieval literature once upon a time. I had this idea my heart was still somehow the centre of my being. True, it is the engine that keeps us breathing and moving. We don't get far without a heart.

The surgery itself went well. My heart was stopped and started again. The mechanical valves clack like castanets inside the cabinet of my ribs. Since one opens and closes with the ingoing blood, and the other with the outgoing blood, I get two clacks per heartbeat which sounds like my heart beats twice as fast as normal. I've gotten used to the speed. When I hear the magnified sound of a normal heartbeat, for example, it sounds way too slow. Like the person might die any moment. Although a normal heart does have a lovely organic sound--flesh and blood pumping. Mine now sounds like a machine. I've more or less adjusted to the loudness of the clacking. What choice do I have? There are some funny stories of how people have tried to muffle the sound of their valves with padding so they can sleep. I tried a wave machine and rain falling. I count in Spanish along with the beat. I remind myself I have two spanking new valves that will apparently function for 50,000 years! How can a surgeon tell you this with a perfectly straight face? It leaves me with an image of myself dissolved to ashes and dust and my valves still clacking.

I don't know how much a cardiac surgeon's time and labour are worth, the cost of an operating room and a heart-lung pump, and a respirator, and the heaps of gauze and equipment and saline solution and all the other attendant doctors, but I priced the valves at the time of the surgery. Each cost about $7,000 US. I quote US dollars because the valves were manufactured in the US, so that's where the figures are available. I live in Canada where we have socialized medicare, so I did not pay for them. 

Here's an aortic valve. I have one of these as well as a mitral valve. Some people show off their new cars. Me, I've got anatomical hardware complete with warranty and servicing agreement. (Servicing includes dental hygiene, blood thinner, bi-monthly blood tests.)

My quality of life has improved significantly. More than significantly since I would be dead without the new valves. I walk every day, I cycle, I hike, I snowshoe. I've been told I can jog but I don't because I don't want to.

I am fortunate that among the many things that can happen to the human body I had something that could be dealt with. I am fortunate that I live in Canada where I've had access to stellar medical treatment.

I have other cardiac abnormalities, which are also a result of having had rheumatic fever, but medication gets adjusted every now and then, and as far as I'm concerned, I'm fine.

Happy Anniversary valves! The sound of your incessant clacking is the sound of me being alive, so... Keep clacking!

mechanical heart valves 3 years ago

Three years ago today my heart was stopped and the surgeons were doing wizardry in my chest cavity. It still somewhat freaks me out.
We, as humans, tend to believe we are what we feel and think. Fact is: we are mired in sacks of flesh, slosh, organs, muscles and bones. Take that away and what happens to all the fine ideals and quintessential perceptions? They don't get far.

For anyone else who has had mechanical valves installed and wants to compare notes: yeah, they make one heck of racket. My chest sounds like a clock ticking inside a cabinet, which you might call a grandfather clock, but I call a grandmother clock since I'm a woman. The tick has a pitch like a porcelain castanet. Since I have two valves--one that opens, one that closes--I get two clicks per minute. I've had to get used to what sounds like very rapid beating of the heart. Sometimes it annoys me. It is so INCESSANT. I'm trying to read and I have this constant click, click, click, click, click, click, click... I tell it to shut up. Except I don't want that either.

In terms of cardiac fitness--again, for anyone else who's going to have or has had the surgery--I think I'm doing all right. I walk approx 2 hrs/day at a reasonably brisk pace. Ideally I'd like to go swimming but I don't like the aggressive swimmers in the community pool, the upheaval of swimsuits, bathing caps, chlorine stink, wet towels. I had thought I might start jogging after the surgery but the beta blockers don't allow that. In the summer I cycle.

I continue to be grateful I live at a time when the technology has been developed to help people like myself, and in a country where medicare extends to all and I did not have to pay for the hospitalization, the surgery nor the fancy porcelain castanets.  

january highs and lows / heart anniversary

So far, halfway through the month, we've gone from -27C to 8C. (Or -16F to 46F.) It's been a mostly grey month with everything from snow to rain to ice pellets to ice rain. I wake in the morning to percussion on the window and try to hear whether it sticks or bounces.

It's the month for a lot of people when the bills from Xmas shopping come in. Bills, bills, too many bills! Why so many? Because there's a cock-eyed rationale whereby people are supposed to give crazily to make people love them. There was a commercial on TV before Xmas where a woman walked into a room with wrapped presents on a table. She smiled at her husband and said, Gee, honey, that's so sweet! This was followed by an alternate scenario where the room was heaped floor, tables and sofa with presents and the woman shrieked, Oh honey, I love you so much!!!

No comment.

I don't care so much about the change from one year to the next. Flipping a number doesn't feel like a watershed moment. I hold more to personal anniversaries. That was the year we moved into the house. This happened after so-and-so died. For R's birthday we went to Mexico. Don't ask me what year or which birthday, but it was his birthday.

January took on more significance a couple of years ago because that was when I had heart surgery #2. It's been explained to me many times that heart surgery is fairly routine. The heart is an easy muscle. The least electrical shock will kick-start it again. And yet--my argument--I only have one heart. If it stops working, I'm stuck. To be who I am, I need my heart.

So there's some anxiety around the whole notion of having scalpels poke around inside it. Also the fact that the heart has to be stopped in order to operate on it. Before the surgery, I had some questions--some in jest, some earnest--as to whether I would/could be the same person once my heart was stopped and then started again. Would some essential part of me have wafted away? Silly concern, but hey, who knows? I'd hate to think that all of what's me resides in my brain. Or wherever.

But it happened. I survived. Two whole years ago as I write. Am I still the same me? Me with two mechanical valves that click audibly. No one told me before the surgery how much racket they would make. When one valve opens, the other closes. When one closes, the other opens. That might sound obvious to you, but you don't hear the double-time clicking. The sound that you associate with a human heart beating sounds deathly slow to me. I get two clicks per beat--a real cha-cha-cha rhythm. It doesn't go with my fairly quiet life.

By now, for the most part, I've gotten used to it. FOR ANYONE WHO'S HAD MITRAL AND ATRIAL VALVE REPLACEMENTS AND FINDS THEM NOISY AND WONDERS HOW LONG IT TAKES TO GET USED TO THE NOISE: I'D SAY 18 MONTHS. Which doesn't mean there won't be times when you grow conscious and it annoys you... when you're trying to fall asleep, at intimate moments, during a quiet scene in a movie.

I came through the surgery fine. Apparently there was never even a chance I might die on the table. Or such a slim one that's it not worth mentioning. The new valves were installed, my ribs were wired shut, my chest stapled close. For the first night I lay swollen from the anaesthetic and barely conscious in a fancy ICU bed while a respirator did my breathing for me. The next day I was breathing on my own and had been sat upright--which hurt, but I was determined to get out of that hospital as soon as possible. First meal of jello and instant bouillon did not tempt, but I got it down. I was the first patient among the ones who'd had surgery on the same day to be walking in the hallway. I'd already walked to the next wing before the physiotherapist came to see me and talk about the importance of getting out of bed. 

The near-death experience came five days later--complications that sent me back to the ICU. 

So I have two anniversaries in January--the day I got my new valves, and the day my heart raced so hard I thought it might leap from my not yet healed chest and the doctors couldn't stop the bleeding. 

Given my thoughts this week, it's not surprising that when I saw this photo of the damage done during the ice storms in Ontario, I felt the wrench of the branch torn from the tree deep in my chest. The effect is all the more powerful because of the contrast--the brilliant heartwood, the dark bark, the white snow, the grey sky. ...And what's that sign about?

Photo taken by the amazing Matilda Magtree at http://matildamagtree.wordpress.com/

We also went to the funeral of a friend who passed away in Dec, but she had kept her good spirits up till the end of a long life, and the service was one of the most joyous and celebratory I've ever been to--an odd comment for a funeral, but so it was. 

update to skumin's syndrome / 15 months after heart surgery

It's been 15 months since I had two heart valves replaced with mechanical clickers. I wrote several posts about this. If you're interested in reading them, the links are below.

What I want to say is that I'm okay now. More than okay. A week ago I went snowshoeing--2 hrs/day, a few days in a row. Strenuous? Some of it was straight uphill. Yesterday I walked 12 k (7.5 miles). Once the weather is nicer, I'll start cycling again.

Indeed, it's possible to have heart surgery and get back to an excellent level of activity--assuming, of course, that's what you want. I'm still fairly young (mid 50s) for having had heart surgery. I was easily fatigued in the months immediately after surgery. I had to push myself. My heart often felt like it was pounding fit to burst. I told my cardiologist who said that my body had to get used to having blood coursing in a way that it hadn't for years. I had to believe that made sense (which it did) and that I wasn't hurting myself by exercising.

Before I had my surgery, I did some research and discovered that there is a non-psychotic mental disorder called Skumin's Syndrome. What can happen--ie it doesn't have to--is that people who've had heart surgery are afraid to push their heart; they constantly check their pulse; they're anxious; the persistent clacking of their new valve disturbs them and keeps them awake at night. GUESS WHAT? YOU GET USED TO IT. You do. You think you won't, but you do. It doesn't happen in the first two months, nor even the first ten months. But you do.

As for the anxieties that characterize Skumin's Syndrome? Trust your doctors. The surgery was done to correct a problem. It's corrected now. Give yourself time to heal. Start to exercise. Go live what's left of your life.

http://alicezorn.blogspot.ca/2011/09/mechanical-or-pig-heart.html
http://alicezorn.blogspot.ca/2011/11/new-valves-for-xmas.html
http://alicezorn.blogspot.ca/2011/12/skumin-syndrome.html
http://alicezorn.blogspot.ca/2012/01/midsternal-line.html
http://alicezorn.blogspot.ca/2012/01/cardiac-surgery-etc.html
http://alicezorn.blogspot.ca/2012/02/possible-complications-post-cardiac.html
http://alicezorn.blogspot.ca/2012/02/life-post-hospital.html
http://alicezorn.blogspot.ca/2012/04/3-months-post-op-cardiac-valves-pledget.html
http://alicezorn.blogspot.ca/2012/05/skumins-syndrome-clicking-valves-sound.html
http://alicezorn.blogspot.ca/2012/08/cardiac-surgery-x-2.html

acting out: cardiac arrhythmias

Maybe only medical personnel or people, like myself, who've experienced cardiac arrhythmia will appreciate this professor. His body movements mirror exactly what my heart has sometimes felt like in my chest. I'm astounded at how well coordinated and imaginative he is. Try to do just one of these movements. I can't. (But I know I've got no coordination.) The best touch is the lab coat. It wouldn't be as funny if he were in a black leotard.
https://www.youtube.com/watch?v=zvWzm7ICzhw

And here's a wee avalanche I saw on a hike in British Columbia a few years ago. The disruption--very small in the gigantic landscape, nevertheless a disruption--also mirrors what my heart sometimes feels like.

cardiac surgery x 2

Tomorrow is the anniversary of my first heart surgery. On August 31, 1983 I had my mitral valve, which was damaged by rheumatic fever in childhood, repaired with a Carpentier-Edward ring which, it was hoped, would keep the valve open for the rest of my life. But the rheumatic scar tissue, which had thickened the valve so that it was no longer functional, began to grow inside the ring. Nasty stuff, scar tissue.
In January, 2012 I had a second heart surgery to replace the mitral and the aortic valves with mechanical valves. That was just under nine months ago.
I don't like convalescing. I'm a bit task oriented. In the first week home from the hospital I began walking, despite the scraped snow and icy sidewalks. I wore solid, flat-soled boots. (The post-op pamphlet recommended shopping malls for these first forays into the world, but I don't like shopping malls.)
Within a month I was cycling on an exercise bike. In fact, my cardiologist recommended that I cycle and get my heart pumping hard so that it wouldn't drum so much when I was at rest. That didn't feel correct. I thought I should rest to make my heart rest. But I trust him and so I tried.
He was right. It's good to exercise your heart post-op. Show it what it's supposed to do. Assuming, of course, that you've had a good level of exercise before you had surgery. Up until my surgery in January, I was still walking every day. I didn't walk fast, I didn't walk far, but I didn't want to go into surgery with a muscle that was flabby, in addition to dysfunctional.
I was still easily tired during these first months after surgery. I took a walk and had a nap. I went to bed early. I had to be careful about lifting because of the strain that put on my chest.
In May I started back at work 2 days/wk and discovered that what tired me even more than walking was people! Within the first hour I saw more people all at once than I had in the previous four months altogether.  
In earlier posts I've complained about the clicking that resonates from my chest. Castanets on the go. I have St. Jude valves manufactured in St. Paul, Minnesota--said to be the quietest on the market. I'd hate to hear what other valves sound like. Or perhaps other people lead noisier lives. I spend a lot of time alone in a quiet room with my writing--and the clicking. Although, with time, perhaps my innards have resettled so that they cushion my heart better. The clicking sounds less intrusive. Or perhaps I'm adjusting. Like R said, the clicking is the sound of me being alive.
I'm still taking a beta blocker to keep my heart beating regularly, though the dose has recently been halved to see how well I tolerate that.
I'm now working 4 days/wk. My job at the hospital is still, by far, the most tiring activity. I should probably have a quieter job, shut up in a room away from people, but I like the people I work with and I already spend so much time alone in a room with my writing. Having a job unrelated to writing was supposed to force me to act like a social creature (of sorts) for a few hours a day.
I decided this summer to forget about the scar that bisects my chest--arrow down the cleavage. When it got hot-hot-hot, there was no way I going to wear high necklines to hide my scar from sensitive eyes who, in any case, weren't looking. The scar wasn't as livid and swollen as the scar I had in 1983--because the surgeon followed the same incision line, instead of cutting into fresh flesh. I would have thought a scar on top of a scar would make more of a mess, but apparently it makes less of a mess.
This dress is especially neat because if anyone is curious and keeps staring, I can easily unzip it to show off more. It's too bad the scar isn't straight. Maybe future cardiac surgeons will do a rotation in plastic surgery as an elective.

 

skumin's syndrome / clicking valves / ambient sound

The note below was written May 11, four months after surgery, when I was still bothered by the noise of my new heart valves clicking. If you're reading this because you wonder if you're the only one who feels frustrated and aggravated by the noise of mechanical valves, then go ahead. Keep reading.
But know this too: I'm writing today, June 19, five months plus a week since surgery. I'm not sure what happens physiologically, inside the body, as it heals after surgery. Does new tissue grow, fill up and muffle the noise? Do the organs resettle and cozy up to each other? Do the valves get used to their new home and clack less aggressively?
The clicking is quieter. My husband confirms it. I still hear it when I'm in a room alone with no ambient sound, but it's duller. At night, I no longer feel my heart thumping against the mattress when I lie on my side. I have not just grown accustomed to the clicking. It is less obtrusive.
There is hope.

But here's where I was five weeks ago...
Before I had cardiac surgery, I wrote a post on Skumin's Syndrome, a non-psychotic mental disorder that  afflicts a percentage of people with artificial valves. These people are anxious, they don't believe their valves work, they lose sleep, they become depressed. I've since been told that Skumin's Syndrome is not recognized by North American or Western European medicine. The Russian, Victor Skumin, who named the syndrome, didn't have a large enough control group to convince Houston, Oxford, Paris, Frankfurt. Only enough clout to get Russians to believe him.

Yet curiosity about the syndrome exists because I get a lot of hits on the site. It makes sense to me that people with these new alien objects in the place where, historically, the soul is supposed to reside, should feel anxious. Even people who don't believe in souls know that their bodies depend on the proper functioning of this muscle pumping in their chest. Someone diddled with it. Someone used a knife. Did that someone put everything back in the right place?
I don't feel that fear. Whatever was cut has by now healed. I'm not afraid of my new valves. I exercise and get them clacking. I don't lie awake worried that they'll stop. I'm not depressed that I have a repaired heart instead of a whole heart.

However. I am aggravated by the incessant clicking of the valves and that keeps me awake. I knew they would click, but before the surgery I didn't fully appreciate what it would feel like to live with the clicking. They click like a grandfather clock inside the cabinet of my ribs. They click like slow-speed castanets on incessant repeat. It's not an organic, skin or flesh sound. It's inside my chest. It never stops.
I try to sleep. The valves click. I wake in the night. They're clicking. I'm in a quiet room where I want to be silent and alone with the door closed, so I can think about writing. The valves click like a stopwatch to harass me.
The surgeon said I should listen to music. Excuse me? I've never listened to music while writing. I listen to music because it's music. I don't do background music.
Of course, I'm fortunate that the valves click because it means I'm alive. The day they stop clicking, I won't be around to hear it. I understand, I understand, I UNDERSTAND.
But damn, do they click. Since there are two valves, I get two clicks per heartbeat. The pace is not relaxing.
A few weeks ago I went to a talk on the North. One of the panelists, Kathleen Winter, who has twice now travelled to the Arctic, spoke of the utter silence of the tundra. Louis Hamelin, also an author who has spent time in the North, spoke of the silence. Ha, I thought. If I stood in any of these places of sacred silence, I would hear my valves clicking.
How loud is the clicking? I hear it now. At night R, who is reading in bed, can hear the clicking. You can extrapolate from that and imagine other times when we're closeup and the soundtrack is ta-tick, ta-tick, ta-tick, ta-tick, ta-tick.
Ambient sound is supposed to help. We have a decades-old ceiling fan in the bedroom that roars and drowns out the valves--while blowing cold air. I end up having to burrow so deeply under the blankets that I can hear the clicking inside the cave of blankets.
I tried a few recordings of rivers on pebbles and waves on sand, but they mostly sounded like a chorus of broken toilets.
I bought a sound conditioner which consumer reports claimed was one of the best on the market--a Marpac. People raved about the ocean surf. I can only assume that these people have never been to the ocean. At low volume, the machine drones like traffic on a busy highway, heard from an apartment window. At high volume, you feel like you're on the same highway, riding on a tailgate. The pitch control  makes the drone more or less shrill.
There's a Youtube clip demonstrating the use of this machine. A man in bed is being harassed by the noise of gunshots. What kind of marketing strategy is this? Gunshots??? What's the correct response to a situation like this? You're in bed, you hear gunshots. Maybe you should call the police. The man in the video clip turns on his Marpac Sound Conditioner, sighs with contentment, and falls asleep.
I wasn't able to drown out the sparrows outside my window, much less anything as loud as gunshots. Or rather: for the machine to be loud enough, I for sure couldn't sleep.
Another sound option I tried was a CD called Heartbeat River, specifically designed for people with mechanical valves. It claims to be a psycho-acoustic recording that will distract the listener from the sound of her own valve--by including random valve sounds with the river sounds. Interesting concept but it didn't work for me. In fact, it began to make me anxious to hear all these un-syncopated valve sounds. I had to keep putting my hand on my chest to make sure my heart wasn't beating like that. The recording lasts for about half an hour. I haven't managed past five minutes without having to turn it off as quickly as possible.
I did find one CD which actually sounds like ocean surf--probably because the quality of the recording is superior. I can play it loudly enough to mask the clicking and still write and read. I'm experimenting with wearing an ear bud at night to help me fall asleep. The CD is called Ocean Surf, Timeless and Sublime, part of Dan Gibson's Solitude series.   www.solitudes.com

motto for a scar

I saw this on FB and decided to copy it so I remember. Photo taken by Martin Turmel.

3 months post-op cardiac valves / the pledget adventure

In January I had two heart valves replaced with mechanical valves. A couple of weeks ago I asked for a copy of the OR report. Who knows, I might one day write an essay about the surgery. I thought I could quote a few fancy words... atriotomy, cardioplegia, anterior leaflet.
I expected the report to be a template piece of writing--routine dissecting, exposing, implanting, suturing. An operation is the one time in your life when you crave normalcy. Status quo. No excitement.
Everything proceeded as per usual until the surgical team discovered that a pledget was missing. "We looked for it for quite a long time." How long is a long time when a patient (ME) is under anaesthetic, with her heart stopped, on a heart-lung pump? And what the hell is a pledget? To me the word sounded like a sharp, poky instrument. I'm going to probe into this septum here. Hand me a pledget.
Unable to find the missing pledget, they had to reopen the left atrium which had already been sutured shut, and poked around until they found it. "We were extremely happy about this." Me too.
Of course, I wondered that no one mentioned this hunt-the-pledget game, which extended the time I was under anaesthetic. I told R who suddenly remembered that the surgeon had informed him after the surgery, but at that point R was in no state to absorb much beyond the fact that the new valves were in place and I was alive. Given the circumstances, I understand. But the doctor should have told me when I was conscious and well enough to comprehend. Ding! Ding! Ding! Guess who the patient is? Guess who speaks for herself?
This, by the way, is a pledget. It looks innocuous enough. Still, nothing you'd want to have sucked up an artery.

Here I am three months later. I've been diligent about walking every day. My tolerance for physical activity is better than it was pre-op. I can climb a hill (slowly) without huffing and puffing. People tell me my colour is better.
My left hand is still partly numb due to pressure the anaesthetist exerted on a nerve for the duration of the surgery. I have to assume that was necessary, because otherwise it would be stupid. I've been told that it can take up to a year for full sensation to return. That's a nuisance because I'm left-handed, but fortunately I'm not a musician--or a surgeon.
Apparently some people have no appetite after heart surgery. That's not been my case.
Apparently some people have trouble sleeping, but that's nothing new for me.
Apparently some people are afraid of over-taxing their new valves. I like to use my new hardware.
The valves click loudly which I have not yet learned to love. The clicking sounds and resounds in my chest. I imagine my ribs as the cabinet of a grandfather clock. The clicking distracts me when I'm reading or writing, and keeps me awake when I want to sleep. Earplugs make the noise louder. Ambient sound might help but I haven't yet found an ambient sound that's ambient enough. I prefer silence when writing.
The greatest inconvenience is the blood thinner which makes me feel like a semi-hemophiliac. Every paper cut requires a heavy-duty bandage. I don't even recall bumping into things but I've got bruises. Is it safe for me to cycle? Answer: no. But how can I resist the bike path all summer?

décolleté

It's grey and the forecast is drizzle and fog. It might not seem a likely day for deciding to put away the turtlenecks I've been wearing since my surgery, but the weather is getting warmer and pretty soon I'm going to have to bare a bit of scar. Perhaps a day when a loosely flung scarf won't look like overkill is the best time to start.
I appreciate that friends keep telling me scars are cool and awesome. But they've all got nice cleavages, so their well-meaning prompts feel like someone in an upper-income bracket telling me my hand-me-down sweater with a patch on the sleeve looks sorta funky. Ie nothing they would ever wear.
I feel like a moth trembling in my chrysalis.
And oh, 10:45 a.m. and I've just noticed that big flakes of snow are dropping so maybe today's not the day after all.

life post-hospital

Having bellyached about my time in the hospital, let me assure everyone that I am slowly but surely healing.
It's been almost five weeks since I had surgery. My chest still occasionally feels like a stiff corset with buckles up the middle, but that discomfort is relieved with a mild, over-the-counter pain killer. My appetite is good. I sleep a lot--long hours at night and naps during the day. The fourth and fifth fingers of my left hand are still numb. And I'm left-handed. I've figured out how to type but can't hold a pen--and boy, do I have fun trying to brush my teeth. Fortunately, I can eat with my right hand. I'm trying to get used to the ticking of the valves. Obviously, ticking is better than not ticking--or I'd be dead. But not hearing the ticking would be best.
I walk every day, and every day a bit farther. The booklet I was given at the hospital tells me to walk in shopping malls where the ground is even and there are benches to rest. Shopping malls are so dreary. The lights, the muzak, the over-breathed air. I would sooner take my chances and walk outside. It's cold and it's winter. I risk sliding on ice. So be it. At least we're having a mild, reasonably dry winter in Montreal. No thigh-high snowbanks to clamber over to get to the next street corner. I walk slowly, but I walk.
Uphill is hard. Last week I had to return to the hospital for a blood test, which meant trudging up the steep hill from the subway to the grey stone castle on the side of the mountain. Ah, the lovely topography of Montreal, a city built around a mountain! It's somewhat less lovely when you're huffing for breath. I had to keep stopping for breaks. Blinking catlike in the sun. Mumbled cursing.
There are various tasks listed in my booklet, which I'm supposed to use as a guideline for what I'm allowed to do. Some make no sense. Fold clothes? Is that so strenuous that it counts as an activity? Not the way I fold clothes. And mini golf? Do people truly play mini golf? I thought it was a torture devised for parents with a carload of children to amuse.
And here on the list is sexual activity. Not to be attempted before you can climb two flights of stairs. I'm wondering if by "sex" the booklet means actual physical rowdiness or simply having an orgasm (which, even achieved gently, increases the heart rate)? And is this "sex" gender specific? Surely it requires more energy to thrust than receive. Though I suppose that depends on the style and the manner.
I'm still post-hospital wary of my body. My legs, okay. I trust my legs. I have my Austrian grandmother's mountain climbing calves. My arms and hands... well, forget the left hand for now. I'm still not supposed to lift anything heavier than 5 lbs. (The booklet seems not to know that Canada switched to metric in the mid-70s.) My back is sore because I keep trying to find contorted ways to sleep so I don't hear the valves ticking. I still feel protective of my freshly hacked torso. This purplish welt from my collarbone to my diaphragm. My flesh zipper. My expensive tattoo. (Though as a friend pointed out, tattoo-wise it looked more impressive when I still had the metal staples.) I drape my neck and chest in collars, turtlenecks, scarves, and shawls.
According to the booklet, I should start driving this week. I didn't realize I needed a driver's license and a car to have cardiac surgery.

possible complications post cardiac surgery

If anyone reading this is about to have heart surgery, bear in mind that what happened to me was unusual. Gastro-intestinal bleeding can follow the intense anaesthetic and heavy doses of anti-coagulants required to work on the heart during valve surgery, but GI bleeding more usually presents as a bout of bloody stools, ie farther down in the body.
The surgery itself had gone well and I was expecting to be released from the hospital next day. The nurse said I could take my first shower in a week--YAY!--and I was walking down the hallway with R to check out the facilities. I suddenly felt the urge to vomit and told him to grab a basin.
Now. I'd vomited that morning. It happened while I had a visitor, and in my embarrassment I quickly folded the piqué across the mess I'd made and gave it to the orderly. I didn't take a good look, but I'd noticed that it was black and grainy. I work in a hospital and had heard the term "coffee grounds" to describe vomit, though I never knew what it meant. I've since looked it up. Molecules in red blood cells become oxidized by gastric acid. Coffee ground vomit means that your stomach is bleeding. I knew that what I'd vomited didn't look right. I asked the orderly to keep the piqué to show the nurse. He didn't. She returned from her coffee break and gave me anti-nausea medication so I wouldn't vomit again. She didn't ask any questions and I was in no state to badger her. I fell asleep.
When I woke, I called the friends who planned to visit that afternoon and told them not to come. I didn't feel well and I was in a foul mood. Though that, in itself, was not so unusual that it was a marker.
Later in the afternoon, when I was looking for the shower, I vomited dark red blood. No mistaking what it was. Everyone reacted quickly. I was dropped onto a nearby commode, wheeled to my bed, and had a  tube crammed down my nose--ostensibly to drain my stomach. The procedure was extremely painful. I asked the doctor to freeze me; he said he had no time. A nurse commented that my narrow nostrils were pretty but made the insertion of a naso-gastric tube very complicated. Uh... thanks. I think. Was that a compliment or a reprimand?
I was rushed back into the step-down unit where I began vomiting fresh blood: bright red gobs of egg yolk consistency. I will never forget the texture of it coming up my throat and out my teeth. Carmine rich semi-coagulated blood.
I shouldn't have been vomiting at all with an NG tube in place, begging the question: was it in the right place? My anecdotal guess--merely present at the center of the mayhem--is that it wasn't, but I seem to have been the only one asking.
The surgeon came to see me. He wanted to know if I had a history of ulcers. No. Never. He explained that upper GI bleeding was a possible complication after valve surgery. He apologized that it had happened. I understood that it wasn't his fault. It was how my body had reacted.
The GI doctors wanted to do a gastroscopy to investigate. My heart rate was over 200. The ICU doctors wanted me shipped to the ICU, but first they had to free a bed.
I realized I wasn't stable. Again, because I work in a hospital, I recognized the language. An upper GI bleed is not a good thing. The fact that the large blue cart--the crash cart--had been pulled up next to my bed in preparation for a cardiac arrest was not a good thing. I had an IV pole over my head with a chandelier of blood products hanging. Bags of yellow platelets, yellow plasma, red packed cells. Also not a good thing. At one point there must have been more strange blood than my own blood circulating in my body. And still I kept spewing it out. The doctors were trying to counteract the anticoagulant I'd been taking to keep my valves functioning. That might help stop the bleeding, but might also clot my valves. I overheard the doctors discussing my case in heated Latinate syllables. The GI doctors insisted that they had to scope me. The ICU doctors weren't sure that my heart would withstand the added stress of a scope. Which was more likely? Bleeding or my heart stopping? No one used the word death. Doctors are superstitious too.
I thought I should say good bye to R and tell him I loved him, but I didn't want to jinx myself either.
A doctor arrived to place a central line in my chest to facilitate access to my bloodstream. The line would have three faucets which could be turned on and off. They would be used to draw blood, as well as give me blood and medication as I needed it. My heart was still racing wildly.
The doctor had unfolded a transparent plastic sheet over the top half of my body, including my face, to make a sterile environment. R was pacing the hallway, bunching his fists in his hair. A doctor friend, who'd stopped by to visit, undertook to keep me talking during the procedure, because I was supposed to stay awake. He began by assuring me that everything was fine. I told him to stop the fucking bullshit. NOTHING WAS FINE. He said, okay, what do you want to talk about? I was lying with my face covered by a blue plastic sheet. My subconscious was in free-fall. The whole while I'd been in the hospital, the nurses had kept giving me messages that my sister had called to inquire about my condition. I knew it was a friend who was calling, but all this talk about my sister--who's been dead for 30 yrs--was beginning to work its effect on me. I was lying with my face under blue plastic, wondering if I was going to bleed to death or have a heart attack. I started talking about this stupid shitty coincidence of lying there with a plastic sheet on my face, because the last thing my sister would have seen before she died was plastic. This doctor friend had no idea what I was talking about. He knew nothing about how my sister died. He didn't know if I had family. But he was very good-natured and kept me talking, even when I called him names.
Another doctor drew arterial blood. Do you know where your artery is? Deep in your wrist. Imagine someone digging around with a fat-gauge needle to find your artery. Why anyone thinks that slitting their  wrists is an easy way to commit suicide, I'll never know.
Finally a bed was ready for me in the ICU, but the transport orderlies couldn't be located. The effort to get me to the ICU would have been comic if I'd had the least thread of humour left.
The GI doctors were still waiting to do a gastroscopy. It was 1 a.m. Again--because I work in a hospital--I understood how dire my situation must be for a medical team to be willing to do a procedure in the small hours of the morning. Partway through, though, they had to stop because my heart rate was too erratic. The doctor said she couldn't stop the bleeding and would have to repeat the test the next day.
The next day my heart was still fluttering madly. I still had the dreaded blue crash cart next to the bed. The ICU doctors debated and decided to try a medication that would either slow or stop my heart. Oh, the suspense. Six doctors standing around the bed watching the monitor as another doctor fed the medication into my IV drip by drip. Guess what? It worked.
I had a second scope that afternoon. The bleeding in my stomach couldn't be stopped completely, but my anti-coagulants had been stopped. I hadn't vomited since 5 a.m. The surgeon felt I had a window of a couple of days during which my valves would continue to function and my stomach might heal itself.
I ended up spending three nights in the ICU. R stayed for all but the last night when I told him to go home, shower, eat real food, and sleep in a bed. A dear friend came to spell him. My friends were all supportive with visits, checking up, bringing food, sending messages. I felt surrounded by a net of goodwill and comforting thoughts--as heartful and helpful as the umpteen bags of blood. That includes the doctors and the nurses who took such good care of me.
When R got home, there were many messages on the answering machine asking about me. Among them was a cheerful voice congratulating me on having won first prize for the Prairie Fire 2011 Fiction Contest. What fantastic news! And what timing!

cardiac surgery etc

Allow me a moment of slobbering sentimentality. I've just spent two weeks penned up in the hospital and am so grateful to be home and in my room again... a large room with wide plank pine floors as they were built in 1901; the recycled oak boardroom table I use as a desk; a futon sofa to loll on (futon because that was all we could get up the narrow curve of the staircase); bookcases along one wall; favourite photos; printer; big dictionaries; writerly paraphernalia. The double sash window looks onto the ad hoc cornices of Point St. Charles. They're simply carved as befits a working-class neighbhourhood, crazily painted as befits the taste of the inhabitants. Two-tone peacock blue and white, matte black, chalk grey, red. Above the flat roofs, the sunlit branches of an enormous oak against a clear sky.
Heart surgery turned out to be the easy part. Yes, your chest is sawn open, your heart stopped, your lungs collapsed, but for the surgeons this is all fairly routine. People have their hearts stopped and valves replaced all the time. Pick a hospital with a cardiac surgery department, look at the OR list, count how many valve surgeries are done per week and do the math to get a round number for the year.
How many mortalities on the table? Bah. None. Certainly not for a youngish woman (I'm talking hearts, not bathing suits) like myself. Statistically, I was pretty safe.
The surgery lasted approximately six hours. I remember being wheeled into the corridor outside the operating theater. It was cold. I thought of refrigerated flesh. People were walking around in surgical greens, caps, and masks.
The next thing I recall was the ICU nurse telling me that my sister had called. Since my sister is dead, I assumed I was dead too. We were now in the same realm. I'd forgotten that a friend had said she was going to call for updates on my condition by claiming that she was my sister. Bad timing, bad joke. I didn't want to be dead and tried to tell the nurse that I didn't have a sister, but I had a tube down my throat. Don't try to talk, she said.
Consciousness wafted on and off. I had nightmarish dreams that I was going to have my chest cut open. Then I opened my eyes to the swimming ICU environment--I wasn't wearing my glasses--and realized ohmygod IT WAS TRUE. Yet I felt no pain because I was medicated.
R squeezed my hand a lot. I remember that--perhaps because he has such large warm hands. Or because he stood by me for hours squeezing.
Dear friends came too, but I have only vague recollections of their silhouettes against the bright ceiling lights. I suppose it's not fair to expect my memory to be stronger than the pharmaceuticals that kept me from shrieking against the pain of just having had scalpels root around in my chest. In any case, what I remember with my mind doesn't matter. Being a sewn-up sack of flesh is the perfect situation to examine the mind-body split. Your mind is anaesthetized, all talk of free will, personality, belief systems useless. Your body is a wounded animal craving solace. My body knew friends had come to bear witness and was comforted by their presence. That's all that matters in the ICU--that your body survives this moment, then the next, then the next. Whatever makes you feel safe, get it. I wanted people, though I know it couldn't have been pleasant to see me intubated, bloated with IV fluids, and unable to speak. Thank you Kathleen, Jean, Saleema, Lina, Matthew, Ahmed and Badar for coming. Thank you most of all to Robert who never left.
The first time I had to roll to the side for the orderly and the nurse to change the bed, I thought my chest would crack. Yet the next day I was sitting up by myself. The body is amazing for what it can withstand.
I was transferred to an intermediate unit for a day, and from there to the ward. I had an IV pump I had to wheel around with me, which required more acrobatics than seemed doable in the middle of the night when I had to go to the toilet. All those wires--one dangling from an IV in my arm, another hooked on the bed rail, another snagged on the bedside table, the pump itself plugged into the wall. Of course, I could have called the nurse or an orderly for help, but I was stubborn. The sooner I was independent, the sooner I would be able to go home. The pump and I did war in the limited space between my bed and the chair where the patient in the next bed (a retired mafioso with a sullen profile) had propped his swollen purple foot. Every time I drew the curtain between our beds for some privacy, he swiped the curtain aside with his cane. He wanted to see the hallway so he could bellow at his nurse whenever she walked past. Poor nurse.
I avoided looking at my scar. I've seen it since of course. It's more crooked than the one I got in '83. Yet it also looks smoother. At the very top, just under the collarbone, there's a protrusion--like a widow's hump, except that it's on my breastbone. Damn. I can't tell yet if that's how the bones beneath have been sewn together or if it's swollen flesh--if the lump will get smaller.
Half of my left hand--my fourth and fifth fingers and that side of my palm--are numb, which is apparently a common complication of  cardiac surgery. Something to do with the placement of your left arm over your head during the surgery. The nurses told me the feeling would come back in a few months. A FEW MONTHS??? I'm left-handed. So I'm trying to relearn how to type with two dead fingers. I can't use a pen. Toothpaste flies as I try to brush with my right hand.
Because the breastbone and ribs are a stable cage that enclose the heart, the pain of cardiac surgery isn't at all like an abdominal or even a neck incision where the muscles pull each time you move. I took only Tylenol while I was in the hospital. I was offered morphine and Oxycodone. I  preferred to withstand the iron corset feeling and not take the stronger stuff because it made me nauseated.
Nausea was by far my biggest concern. However, I recalled being nauseated from the last time I had valve surgery and wasn't surprised. Nor was the hospital food in the least appetizing. Hot meals were gluey and colourless. Sandwiches came in a choice of yellow, beige, or darker beige: egg, chicken, or tuna. Even the drinking water stank of hospital sanitizer. R brought my favourite foods but I wouldn't even let him unzip his knapsack. Just the idea of food made my guts curdle. I told the nurses that I was nauseated+++++. But they, too, were familiar with the nausea that commonly follows cardiac surgery, and didn't suspect that I had trouble brewing.
One day I had a long run of atrial fibrillation that wouldn't stop. My heart fluttered high and hard in my throat for hours. It was exhausting. Well, yes, at a heart rate of 150, I might as well have been jogging all that time without stop. But apparently a-fib post-op day 2 is common. I was put back in the step-down unit and given a drip that stabilized my thundering rhythm.
Back on the ward again, I did my best to get ready to be discharged within the 5-7 day time frame I'd been given for post-op stay after cardiac surgery. Who wants to stay in the hospital an instant longer than they have to? I walked in the hallway shoving my unwieldy pump. I coughed as I was supposed to. I still couldn't eat. All I could tolerate was ice. Before mealtimes I asked for anti-nausea medication, but it didn't really help and made me sleepy. Nausea, nausea.... I just wanted to get home.
My chest tubes were removed--fat slithery worms that had stopped draining fluid from my chest cavity. How were they removed? They were pulled. One, two, three, take a deep breath. Ewwwwww. R asked the nurse if my insides weren't going to ooze out the holes. She looked a bit shocked--didn't realize he was joking. Though maybe he wasn't.
The pacemaker wires were tugged out. One was sewn to my heart, the other a ground. The nurse took care to make sure they weren't tangled. Though they were only wires--much thinner than chest tubes--removing them pinched more since they'd started to fuse with my flesh.
My blood thinner had finally hit the target mark for mechanical valves, so the IV pump was removed. I could take a shower! The next day I could go home, and would surely get my appetite back when I was eating proper food again. I was determined to get out.
But that's not what happened. I ended up spending another full week in the hospital, much of it in the ICU. But that will wait for another post.

midsternal line

Here, where the skin is smooth—below the collarbone, above the breasts—press your hand flat, slide it down to where the diaphragm starts. Trace the line, almost faded, made by the surgeon in Toronto 30 yrs ago. Do it now before the flesh is cut again.

what the body remembers

pitpatPATPATPATPATptptptpt (pause) PITpatpitpatpitpat
I never thought I had such a silly heart, but boy, it doesn't take much these days to kick up a jig.
Of necessity, New Year's Eve will be quiet. R and I will stay home.
On the menu: grilled salmon. Just before the salmon is finished, we slather it with pesto, top that with finely sliced marinated dried tomatoes, then back under the grill till the edges of the tomatoes char--only a minute. The salmon is served on a bed of baby arugula lightly dressed with lemon and olive oil. Feeble heart doesn't mean I've lost my appetite.
Later in the evening I might start knitting a sweater with the gorgeous kettle-dyed merino wool R gave me for Xmas. The brand is called Malabrigo Rios. Variegated yarn so luscious in texture and colour that I hold it and marvel--partly because I worry it will look a lot less rich once I start to torture it with the needles.

I haven't knit a sweater for close to 30 yrs. My hands still know how to knit, purl, crossover, increase and decrease. I can cast on like I did it just yesterday. The movements aren't the problem. I'm alarmed at the revolution in knitting patterns. I've only ever knit from the bottom up--the back, the front, the sleeves. You knit distinct pieces, then sew them together. What's this nonsense about knitting a whole sweater in one piece from the neckline down?
The two helpful women who work at Mouliné, an excellent yarn store on Notre Dame in Montreal, tried to convince me that knitting like this works very well. On a circular needle the weight of the yarn gets  distributed more evenly, there are no bulky seams, etc etc. Two women, who were sitting at a table knitting, got in on the discussion too. Yet even as this charming bevy of advisers encouraged me--and even as I agreed with them, appreciating their advice--I thought it was crazy. I'm not ready for a neck-down project. I want a bottom-up pattern. I'm not against trying something new, but not for the first time with such expensive yarn, and not when I'm going to be convalescing from surgery, unable to take my botched knitting to the store for help.
I don't make New Year's resolutions. Birthdays are my watershed for wondering where I've gone and where I'm going next. New Year's is when I have to remember to write a new number for the date. I'm happy, too, that the short winter days are starting to get longer.
Okay, back to looking at for a pattern that makes sense...
I'm relying on my hands to remember how to knit. I'm relying on my wonky heart to remember to keep beating.

happy holidays

I risk getting sentimental here--hey, it's Christmas--so stop reading if that bothers you.
Yesterday I received a wonderful gift in the mail. Let me show it to you to see if you can guess what it is. The corner of print on the notepad isn't a clue. That's just one of the many notepads we have lying around. R works at a cemetery. He's not a gravedigger, though that's what he usually tells people when they ask. I suppose it sounds more exciting than telling them about the mounds of paperwork that have to be processed each time a family member tries to get in on the family plot, to buy a niche in a columbarium, bury a small urn, not to mention a coffin. (Do you know what a columbarium is? R's job has introduced all kinds of bizarre vocabulary to our conversations at the dinner table.)

The friend who sent the gift suggested that I could think of as plated chewing gum.
The melted tin soldier from the sad children's story.
An abstract reindeer head.
Roadkill.
I enjoy her grim imagination. She's a gal after my own heart. (That's a clue.)
In fact, I love what she imagines as possible substitute shapes almost as much as what it's supposed to represent which is an anatomical heart. See the pulmonary artery up top? The vena cava?
When I consider the blobby shape of a real heart, I'm not sure who came up with the stylized shape we see at Valentine's.
Another friend gave me one of these hearts--in soapstone to fit exactly into my palm.

R and I will be spending a quiet Christmas Eve at home. The most excitement around here will be the beans baking at 250F in the oven. Mais oui, in Québec: beans and tourtière on Christmas Eve.

skumin syndrome

By chance I discover that the various manifestations of anxiety related to heart surgery have a name: Skumin Syndrome. Feelings of vulnerability, doubt that the new valve functions correctly, negative visualization of this alien metal in the much-vaunted seat of the soul. It's no more nor less than Skumin Syndrome.
I'm humiliated to have worries so common they've been noted, analyzed, catalogued and given a name. I've never been one to follow trends. Square-toed shoes. Ruffled swags at the window. Songs by Pitbull. Why start now?
If 79.6% of patients, following heart surgery, have trouble sleeping, damn it, I mean to sleep soundly! I hope to regard the soon-to-be non-organic components of my heart with... well, I'll aim for forbearance. Not sure if I can summon up actual affection. I will not sneak my finger to my wrist to check my pulse repeatedly; obsess on the rhythm of my heart; dash into pharmacies to test my blood pressure. I will trust that the surgeon has well and truly repaired my dysfunctional valves with snazzy foreign metal implants. (I should probably stop thinking of them as foreign.)  
I still don't have a surgery date and begin to suspect that I won't have my new heart for Xmas. I'm appalled to imagine how many people have hearts more frail than mine--since they apparently need surgery more quickly than I do. Do they all have Skumin Syndrome?
I am ever-grateful that I write fiction because that's the best way to keep my mind occupied. None of my characters need heart surgery which means--while I'm working on my novel--that I completely forget that I do.

new valves for xmas

For Xmas I'll be getting two new heart valves and a new scar. Rumour has it scars are fashionable. I wonder if that rumour includes a zipper down the cleavage. Maybe I can start a fad with the valves too. Why keep a fallible biological valve when you can have one of these shiny metal ones that only stop clicking once you die? (Or they stop AND you die. The logistics still aren't clear to me.)
The date for surgery isn't set yet, but I've been assured the deed will be done before Xmas.
So the holidays will be quiet this year. I won't be baking tourtières and Viennese Christmas cookies. Nor building an amazon snow woman with my niece. Nor dancing with her and her mom to Trinidadian calypso. You don't do your duty, I don't make you roti. My niece and sister-in-law belong to R's side of the family. My family live elsewhere. Ties aren't close.
I'll be spending the holidays at home with R--or at least, I hope I'll be home. Who wants to spend the holidays in the hospital? Wherever I am, if I'm conscious, I'll be having a big glass of wine.
I've stocked up on books. A friend has offered me the loan of her CDs of author interviews from the archives of the British Museum, including Virginia Woolf (!!) and Conan Doyle. I bought some teal yarn--a cotton and silk blend--to knit a sweater. I have a lime-green embroidery hoop and some thread and patterns. Embroidery seems a good convalescent type of occupation. I don't expect to get past a floral trail or two, but I'd like one of those densely embroidered velvet tunics that I saw in Mexico last spring. I figure embroidery is like writing: you start small and project ahead.
Except for having bought new pyjamas and planning what might keep me amused when I'm housebound, I'm trying not to think about the surgery too much. It will happen when it happens.

a mechanical or a pig heart

Yesterday R and I met with a cardiac surgeon to discuss my heart. The aortic and mitral valves need to be replaced. These are the intake and output valves on the engine. I know the actual anatomical working isn't  that simplistic, but visualizing it like this helps me understand what’s going on in a way that the words atrium and diastolic don’t.

I  knew that I needed the valves replaced before seeing the surgeon so I wasn’t knocked off my chair by the news. We met with him to discuss options. Namely, what to replace my currently dysfunctional valves with: a tissue (pig) valve or a mechanical valve.

The advantage of the tissue valve is that it mimics the human valve best. When a tissue valve starts to degenerate, the process is gradual. I would get short of breath, etc. I would have all the symptoms I’m experiencing now and know that it was time to have surgery again.

That’s the disadvantage of a tissue valve. I would need to have my chest sawn open again in less than ten years. I’ve already had this done once. I’m not looking forward to having it done again. I don’t know that I’m up for a third date.

However, a tissue valve would be the best bet for a woman who still intended to have babies, which is not my case. That the doctor even mentioned babies was sort of cute.

The mechanical valve unfortunately looks like something that belongs in a gasoline-operated lawnmower. I admit I’m not mechanically inclined. Two plastic flippy lids that open and shut inside a ring don’t instil me with confidence. And I should get two of these in my heart? I don’t know.

In order to keep a mechanical valve functioning, I’ll have to take a blood thinner which will turn me into a walking bruise. Believe me, at the rate that I walk into doorframes and trip, it will. Not that a bruise would kill me. But a hemorrhage could.

The advantage of a mechanical valve is that it doesn’t deteriorate. I wouldn’t need surgery again. At least not to replace the valves. If a mechanical valve stops opening and shutting, there’s no time to do surgery again. From one minute to the next, the heart stops. The doctor assured me that was a rare case scenario. I was the one who brought it up, not him.

Basically, my decision will be between living with anti-coagulants or looking forward to another heart surgery. Assuming that I live another 10 years and that this surgery goes well. Knock on wood.