A Follow-Up

A Follow-Up

I was due to have a follow-up appointment with my surgeon some weeks after the operation, but in view of the problem I'd had with the atrial fibrillation, I requested an earlier date, just to make sure everything was going along well, and an appointment was made for me on 9 March.

I went with Wendy, and had a very thorough meeting with my surgeon; it was very reassuring to be told everything was healing well, and my sternum was stable. We discussed the medication I'd been prescribed during my stay in A&E, and I was advised to stop the Rivaroxaban, and return to taking 75mg of dispersible aspirin instead. I was really pleased about that, because I felt the Rivaroxaban was quite a strong medication, and I am at least more "at home" with aspirin! I'll still tell people like my dentist if I have to have a filling or any other work done that I am taking a maintenance dose of  aspirin, and of course I only ever take it with my breakfast, or other meal - never on an empty stomach!

I mentioned I sometimes feel short of breath on exertion, but today my blood pressure and heart rate were fine. 

It was nice to have all my questions - and the ones Wendy presented as well - answered, and it was a case of so far, so good. I have lost weight because I have been on diuretics, but I can stop those now, and I should soon regain the lost kilos - I'm eating well, thanks to Wendy's good cooking and everyone's encouragement.

Because Wendy's dad suffered a massive heart attack when he was only 59, and now with me having undergone surgery with "interesting" variations from the norm, we asked if Wendy should also be checked, to make sure she is safe and well? It was agreed that, although there is no rush, it would be a good idea, and my surgeon said he would be happy to refer Wendy to a consultant on the NHS. However, in view of the way things are at the moment, and likely to be for the foreseeable future, we said we'd really prefer to go directly through him; so later this year, we will request an appointment with him, and some tests to make sure all is well. 

I think we all like to feel we are under the care of someone who knows us now, and who can see us when it is necessary; it gives us peace of mind, which is worth so much!

 

Another Complication

Another Complication 

Monday morning, 1 March, started well. I had a good night, got up for breakfast, managing half a Weetabix (I was always a "two Weetabix a day" girl, but I knew I'd have to build up slowly!) and tea, feeling really relaxed.  I went out to feed the fish, and walked around the garden, just enjoying the sunshine, and being home. I had rests throughout the day, and come the afternoon, mindful of the physiotherapists' advice that I should walk every day, and go a little further each time, I decided to get my coat on and do my 6 minutes stint outside. 

As it turned out, it was not such a good idea after all. A cold wind had got up, and although I reckoned I was warmly dressed enough, I felt terribly cold. Back indoors, I checked my pulse rate - I knew it should have gone up, and then slow down back to normal after a fairly short time; but on this occasion, it didn't; my pulse rate carried on increasing, and it was extremely frightening when nothing seemed to calm it down.

I rang Al, and he gave us several tips on how to check what rate my pulse was going at, but it became impossible to count, and he said I should not wait, but ring 999 and request an ambulance. 

I took his good advice, and within a few minutes, the paramedics arrived and started carrying out checks on me, with the decision quickly made I needed to be taken to A&E at the local NHS Hospital, under sirens and blue lights! Good grief - this was not the homecoming I had hoped for, but clearly they thought it necessary. 

Throughout the journey, the paramedics kept checking on me, and on arrival I was taken straight through to A&E. I was put in a cubical, and a lovely male nurse came in to see me  and fit a cannula, and then over the course of the next couple of hours, I was seen by various Doctors, who confirmed I had Atrial Fibrillation, and they prescribed bisoprolol and magnesium and furosemide - and probably other medications I can't remember! - and ECGs.  When I explained I had undergone aortic valve replacement surgery a week ago, one cardiac specialist told me about 40% of patients who have surgery develop AF, so it wasn't exactly unexpected; but it would have been nice to have been in the 60% of people who managed to avoid it.

It was all very nerve-wracking, to say the least, but during my stay, I met many very kind and concerned Doctors and nurses, and at last my heart rate returned to a normal rhythm. I was told would probably have to stay in hospital for a few days to see how things were going, and that I also had a pleural effusion on my lungs, which might need to be drained - this would be done under local anaesthetic and was not a difficult procedure. It was pretty horrible to realise I might have to face yet more treatment - even if only minimally invasive! - after having gone through so much already.

There was no bed available on a ward for me, so I was still lying in A&E when to my total surprise and delight, Al suddenly materialist by my bedside!

"Oh, Al!" I said, " I can't believe you're here!"

"Well, Grandma," he said, "you know if you want to see me, all you have to do is dial 999!"

As soon as he knew I was going to be taken to A&E, Al had got in his car to drive up to London. In the meantime, Wendy had made sandwiches for me - again, a selection of cheese, shredless marmalade and strawberry jam - and put them in a bag with bottled water, my toothbrush and toothpaste, tissues, etc. - in fact, anything I might need over the next day or so, and as soon as Al arrived, she had given him the bag to bring to me in the hospital. 

It was just wonderful to have him with me, even if only for a few minutes; it was a great morale-boosting treat to know he was there! 

After some further time in A&E, a bed became available on the Medical Receiving Unit, so I was transferred there, and the staff continued monitoring me, making sure my heart rate stayed stable. I had regular visits from various specialist doctors, who were all kind and helpful, and with varying ideas about how to keep me safe in the future; with some, I also had such interesting conversations; they all came from different backgrounds, and I learned so much.

I ended up spending 4 nights in the Department. It was decided I should take Bisoprolol to help my heart maintain a steady rhythm, and medication called Rivaroxaban, to keep my blood thin enough to protect me from further problems. I would have to carry a card to show I was taking it, but it least Rivaroxaban would not require me to have regular check-ups, as I would if I was on warfarin.  

I had to laugh a bit, because the pharmacist who came up to see me to explain the seriousness of taking Rivaroxaban was very particular about telling me that yes, I would be able to drink alcohol whilst on these pills, but I must be very careful not to get to a stage where I could be so intoxicated I might fall over, as that could cause me to have serious bruising and blood loss...  

"It's fine," I said, "I actually don't drink - or only very rarely: say a sip of champagne to toast the Bride and Groom at a Wedding - I don't like the taste of it!"

I also explained one of the reasons I don't drink is because I sing a lot, and when I am on stage, I want to be razor-sharp, my concentration on my performance  totally focussed... but still I got the idea that she didn't quite believe me, and repeated I would have to be careful not to over-indulge. 

"Well, then," I said, "I shall just have to make jolly sure I don't fall off the stage!" Heigh ho.  It's sometimes hard to convince folks that my real enjoyment - and the equivalent of most people's "wine o'clock" moment after a hard day's work - is actually a lovely hot cup of tea, a bar of Cadbury's Dairy Milk chocolate, and the Telegraph cryptic crossword!

It was also confirmed I had what one Doctor called Dressler's syndrome, which is fluid in the pleural cavity of my lungs. This is also common after heart surgery, and can be removed by inserting a needle and aspirating the fluid. I was really disappointed to hear about this development, but I was reassured that it was a simple procedure, and if I needed to have it, it would be carried out under local anaesthetic. 

By Friday, the consensus was that I was back in normal heart rhythm, and if another echocardiogram showed all was well, I could go home. I was so relieved; I knew I'd have to stay on the bisoprolol 2.5 mg tablets, but it was a small dose, and if it kept everything running smoothly, that was fine by me.

The echocardiogram was satisfactory, so I had another evening discharge, with Bob and Wendy coming to collect me. It would be lovely to think I can now look forward to really being at home now, and making a good recovery in my own time!

Whilst I was in hospital,  I'd had time to think about the way Bob, Wendy and Al had really been there at all times for me, ready to fight my corner - especially organising my move to a better room at the hospital where I'd had the operation - and making sure I had whatever I needed after my emergency trip to A&E. As I've said before, it's not in their natures to be very demanding and "front of house" - that's usually my role! - but they had done me proud and I got inspired by and for them. I wrote "Rottweilers" as a tribute to all their successful efforts:

ROTTWEILERS!

You have become Rottweilers,

With snarling lips and fangs

You will get across the drawbridge

’Ere portcullis clangs.

 

For there are many arrows

You’ve had to dodge and jinx

And other tireless dangers -

Like rampant, pouncing lynx!

 

And still you have to persevere

Any by some cunning guile

Get through until we won the day

And hurdled every stile. 

 

You all have fought my corner

When troubles came to knock;

Four strong, we cling together,

We stand as solid rock.

 

Alexandra Wilde

 

Written in Hospital A&E, March 2021

I Go Back On The Ward

I  Go Back On The Ward

At last I was given the great news: "We're going to take you back to your room on the ward!" and I was wheeled in the bed back to the ward. I felt this was good progress, to be out of Intensive Care and, hopefully, on to the next stage of recovery. 

There was a hiccup along the way: I was not put back in the room I'd occupied when I was admitted, but instead found myself "parked" in a much smaller "box room."  It did have a t.v., and a bathroom, but it was shaped like a square box, with enough room for my bed to fit in, and not much else. Talk about being claustrophobic - there was not space to swing half a cat. 

It was really hard not being allowed visitors, but I was very prepared to abide by the restrictions caused by the virus. It helped that I was beginning to feel more able to make sensible calls, and although I still made some errors in my messages, Bob and Wendy were able to contact me, and I could tell them what sort of a horrible room I was in now. 

Unbeknown to me, Bob then telephoned the ward sister, and complained on my behalf. I have no idea what was said - he is very tactful, extremely diplomatic, but can get his displeasure across when he has to! and a little while after that, my lovely nurse came in to see me again and said, "We're going to move you, back to your original room!" 

I think she realised how pleased I was to be out of such cramped conditions, and soon I transferred back to the same place I started off in, on Sunday afternoon. It felt like a welcome homecoming, where there was space to breathe.

Over the next few days, I made progress.  I saw my surgeon every day, and he was very pleased with the way I was getting on; every morning and every afternoon, I had physiotherapy, going for short walks out of my room, along the corridor, with a very reassuring lady who held my hand (I felt quite wobbly!) as I tottered along. It was all a heavy effort, but I knew I had to make it, and there were other patients in the same boat as I was, grimly lurching forward and determinedly going as well as they could. It was encouraging to see the people who were further along the recovery path than I was, walking more confidently. 

I remember from the time 52 years ago, when I broke my sternum after a car accident, how painful it is whilst the bones heal; at the age of 22, my breast bone mended after a couple of months, but even at that young age, it hurt terribly when I coughed - or laughed, or sneezed! (Please don't tell me any funny jokes for a while...!) 

I was given a rolled up towel to hug when I needed to cough, to try and hold myself together, and it did help; but mostly I was able to try sitting up and put my arms around myself to keep everything as still as possible. 

After the operation, I had gained 7 kilos - going from 62 kg to 69 kg, so I was put on diuretics, and weighed every day, to check the fluid was dispersing; it was working, but of course meant I wanted to spend a penny very frequently! 

Another problem was that I was now anaemic. Before surgery, my blood count had been 14, which was good, but during the operations, I had lost so much blood, and even though I had had a transfusion of 6 units, that had brought me back up to a count of only 9. It was no wonder, then, that I felt weak and tired and a bit "maisy" - dizzy - on occasions. 

The nurses all reminded me of the mantra: "CALL, DON'T FALL" and I followed their advice to the letter. It meant they were in and out of my room to make sure I was safe getting to the loo, and it was also bliss when I could get to the bathroom and wash my face, leaning against the side of the basin for support, and brush my teeth. It was pretty exhausting, but so worth the effort to feel fresh again. Yippee!

I managed to eat something every day - at breakfast I had a few cornflakes and tea, and for lunch and dinner, I ordered the same thing - plain chicken, well done, with boiled potatoes and butter, and ice cream. Even though it was not exactly to my taste (the boiled potatoes were whole, tiny, new potatoes, left unpeeled - and also quite hard!) it served well enough. I could eat only a few mouthfuls anyway, because it hurt so much to expand my chest, but I did try. 

The best thing was, Wendy  made me more sandwiches, and got them delivered to me via the porter on the front desk.  She knows exactly what I like, and made a few with lovely crumbly cheese, some with orange shredless marmalade, and the rest with strawberry jam - delicious. She wrapped them all individually, and I put them in the fridge in my room; I didn't starve.  

During my regular peregrinations along the ward corridor with the physiotherapist, I made the effort to try and re-establish singing and talking. Having had the tubes down my throat for so long, I was really worried about damage to my vocal chords; my voice was pretty rough to begin with, but gradually I was able to complete one short chorus of Steel Rails, and on other occasions, I recited my poem I'd written about the West Somerset Railway, "Steam Dreams."  The first few attempts were pretty dire, but at least I felt I was trying, and concentrating on poetry and song took my mind off how I was feeling! To my delight, the physiotherapist asked me if I knew the work of William Butler Yeats and of course I immediately said he was one of my favourite poets. I launched into "When you are old, and grey, and full of sleep..." She knew the poem as well, and the sad story of lost love behind it; it was so nice to have that rapport with her. 

By the Sunday, I was still gently toddling along, and prepared to stay in hospital for a couple more days, as arranged. I saw another physiotherapist, a gentleman, who was really terrific, and he got me confident about walking up and down two flights of stairs; I took my time, but it was a great feeling to know I could do it, especially as there would be stairs to climb when I got home. 

My consultant came to see me again and, to my great surprise, asked how I would like to go home that evening?!  He said he felt I was well enough, and I would make better progress continuing my recovery at home. There followed a few phone calls and, within a very short time, it was agreed I could be discharged  - talk about swift decisions! but I was pleased the consensus was that it would be good to get me home. 

I had to have a couple of stitches taken out, from where drains had been removed; up until then, I had been wearing hospital gowns, and another lovely nurse who cared for me helped me have a shower, and got me dressed in my own clothes.

So there we were. It did not take me long to re-pack! and in the evening, Wendy and Bob drove to the hospital and waited for me whilst the porter brought me downstairs - I had to use a wheelchair, but I knew that would only be a temporary form of transport. 

It was wonderful having the evening air on my face! and I managed just fine in the car. Although I gather if you have recently had open heart surgery, wearing a seat belt is not obligatory, but I put a cushion up against my chest before fastening it, and felt safe enough like that. 

And so we got home. Wendy made me tea, and never has a home-brewed cuppa tasted so good. I was able to check out the post, check my e-mails... and see what had been going on during the week - that feeling of normality gave me such a mental boost! and I felt very prepared to continue my recovery at my own pace. 

Into Intensive Care

Into Intensive Care

About 24 hours after the start of the first operation, I finally woke up; the first words I heard were from a lovely Irish nurse, trying to convince me it would be a very good idea to get up at once and sit in a chair for a few minutes. 

Even with the effects of the anaesthetic causing me to have strange visions, I can still remember everything about her gentle persuasion!

She said, "Come on, now, Alexandra; you're a fine woman! You can do it!" 

"No, I can't," I said, "I'm a cat. Meow."

"I love cats," she said, "and you can do it!"

Well, in spite of having very, very strange visual disturbances after all the anaesthesia I'd been given, I realised I had to make an effort; but my goodness, it was a terribly hard effort. 

And it was very slow. But somehow, I managed to get my legs off the bed, and with the nurse's help, I got up. The next bit is still rather hazy, but I think having managed that initial stage, I was able to lie down again, and what a blessed relief it was. 

I knew they were not real, and the the weird visions I was experiencing were not frightening, but I was seeing huge areas of what looked like pink sphagnum moss swirling and whirling on the walls, rearing up like the great long neck of the loch ness monster, before collapsing into another shape and then changing again and again. Another vision was as though I was on a fairground ride - not a big dipper, but one going through various tunnels, and there were strobe lights going round and round, to make you feel giddy. I have actually been on a ride like that once, and I could stop the sensation now, by closing my eyes, but I was still aware the "whirligigs" were on-going, projected on to the walls. 

Later, when I told him of these ... hallucinations? ... Al's comment was: "Grandma: there are some people who pay an awful lot of money on drugs for these experiences ... and you had what they would call 'a bad trip'!" 

Such "psychedelic trips" I can definitely do without. 

The nurses had looked after my mobile phone with the WhatsApp facility on it, and I remember trying to call home; I knew exactly what I wanted to say - my  mind was clear enough for that - but my fingers wouldn't obey my instructions for typing a message, and I sent a couple that were truly garbled. Oh dear. At least, I guess everyone knew I was awake at last, and trying hard to communicate.

Later, I wrote a couple of tone poems, detailing what I'd seen under the influence of the anaesthesia; looking at them later, I realised how compromised my handwriting and co-ordination had been, but at least I had been able to write something down, and it was legible enough for me to read it afterwards. I also wanted some reassurance that I was regaining the ability to think and write creatively; it was a relief to feel it was coming back. 

Here, then, are my most immediate efforts at recording what I was seeing in Intensive Care: 

VISUAL DISTURBANCES 

 

1: Sphagnum Moss

 

Sphagnum moss – but it’s pink, not green

In swirling shapes, every changing scene

One moment like a murmuration of starlings, the link –

But not black, it’s pink.

 

The changes seemed to spread, great pink meshes

Metamorphosing into bug-necked monsters

Heads collapsing onto breast and dissolving

Into wilder and wilder concepts, moment to 

Moment changing into a more extreme form

Of blob.

 

Shall it ooze underneath the doorway – and

Regenerate itself skywards? But no! It has

Climbed, to even greater heights, splitting,

Dividing until night sky is filled with pink

Dots, swirling never ending circles, moving

Round until there is no more sky.

 

 

2: Fairgound Ride

 

Rolling lights – a fairground

But this is ICU

Not for these residents

Happy holidays

Close your eyes

Concentrate on other senses

In your head –

Better than lights to make you

Dizzy –

Better than lights to confuse.

 

 

Alexandra Wilde – Intensive Care poems: 23/24 February 2021

 

 

 

I Undergo Surgery

I Undergo Surgery

I didn't get much sleep that Sunday night. I was up early, because I'd been told I would be going to theatre at about 2.30, and I would be allowed a very light breakfast - cereal and tea - but as I had to be finished by 8.00 a.m., it would be brought to me by 7.00 a.m. In the event, the instruction for an early meal got lost somewhere, so I ended up having just a slice of toast. I wasn't terribly hungry anyway, but I was glad of a cup of tea. 

Then I was told I needed to pack my suitcase again, because my belongings would be taken to a safe place whilst I was in theatre, and during the time I was in Intensive Care. I had a shower, and was given a gown, jazzy red non-slip socks and nettie knickers to wear, and the time soon whizzed;  and then I had to climb on to a special trolley for the trip to the operating theatre. 

The first thing I noticed was that it was covered with a peculiar plastic/rubber material - whatever it was, it was very cold, and I remarked on it, but there was no explanation, just a swift transfer and I got the feeling that by this stage, everyone was just galloping along: It was literally "all systems go," and there was no time to waste.

I knew there were a lot of people thinking of me and praying for me, so many friends and all my loved ones were all keeping me close; and on the journey to the theatre, I also prayed for courage. I remember thinking I could hardly believe I was actually doing this, and almost ready to face major surgery, and I did not feel very brave. It's a weird feeling, knowing you are so far committed to everything, and there was no pulling out of it now! 

As I was wheeled into the ante room adjacent to the actual operating theatre (maybe patients never get to see that room!), I was met by my anaesthetist. It seemed to me to be very small area, and really filled up with ... I don't know what, equipment, I suppose, but it certainly felt cramped! I was aware there was no small talk, just very calm, cool efficiency in the few seconds it took to organise the preparations; I asked if I should count down when I had the anaesthetic, but I cannot even remember what anyone said, because I was swiftly asleep. 

Later, when I was given the report of my operation, it made quite scary reading. Much of the procedure I knew anyway, and it was comforting to know that it had all gone according to plan; the new valve had been implanted, and then my heart had been restarted without any problems. During surgery, my body temperature had been reduced to 32 degrees, which possibly accounted for the very cold material I had been put on to begin with. 

However, after the operation, and some hours after I had been taken to Intensive Care, it was noticed I was losing blood, so my surgeon was recalled; he decided to revisit the site, and see what was going on. The realisation I had been opened up again was quite a shock, but my right mammary artery was bleeding, and this had to be stopped. Then my sternum was put back together again, and I was sent back to Intensive Care for a few more hours. 

I later found out my surgeon had kept in touch with Wendy and Bob throughout this time, and kept them informed of my progress. When Al discovered I'd had a second operation, his immediate reaction was, "I think you guys need some company!" and he was able to relinquish his paramedic shift and drive straight up to London. 

I Have Been Having Adventures...

 I Have Been Having Adventures...

If anyone wonders why I have been away from writing anything on my blog for a few weeks, there has been a very good reason for it. I have been having adventures - not ones that I would have wished to endure, but which I could not dodge, and had to face up to.

On 22 February, I underwent open-heart surgery to replace my aortic valve; it was severely stenosed with a lot of calcification, so I was in sore need of a new one. 

It's not something anyone would blithely put themselves in for, but I realised there was no time to waste; it was urgent and the sooner I got on with it - and got it over! - the better. I had a wonderful surgeon, who inspired me with confidence, and also reminded me it would be good to have the surgery whilst I was still young ("Keep talking to me!" I said, "keep talking to me!") and on a technical note, I had also been born with a bicuspid valve, which meant I had only two leaves instead of the more usual tricuspid valve with three leaves, so although a TAVI (trans-arterial valve implantation) was an option, it was clearly better to have the operation where the surgeon could see clearly what was going on, and he would be able to clear the calcification at the same time. 

Although it terrified me - of course it did! - I agreed to go ahead with the open-heart option; and at the beginning of February I got an e-mail asking me if it was still what I wanted. I didn't think twice, I just e-mailed back to say yes. The date also fitted well with Wendy, because she had booked three weeks' holiday  then, and would be able to help to look after me when I got out of hospital.

I think I went in to a sort of dream-like state for a couple of weeks; I heard from the hospital that I had to attend 72 hours before I was admitted, to undergo the pre-operation checks as well as swabs for the virus, to make sure I was clear of everything, and well enough to have the surgery. On the Thursday, I went in for a couple of hours; apart from the swabs, there was an X-ray and blood tests and it all flowed very efficiently, and I was soon able to go home. It still felt quite unreal, as though it was all happening to someone else - certainly not me! 

There followed a strange 72 hours,  until on the Sunday morning, I had to get ready - case packed, early breakfast, and then the trip to the hospital for admission at 2.00 p.m. No-one could come in with me; at the entrance, I was met by a porter, who took my case up to the room.

It was just like being in a hotel - going in, there was a wardrobe and coat pegs on one side, an en-suite bathroom on the other, with the main part of the room filled with a bed (hospital style, of course!) and a dressing table, with a large t.v. mounted on the wall, and a couple of chairs. 

I swiftly got my belongings organised; I'd also taken some paper for writing, and a couple of bits of mending for Wendy (with hindsight, did I really want to be doing much with needles and thread?!), and an art paper pad and coloured pencils, in case I wanted to do some drawing. 

Presently, my consultant arrived to see me, and spent a long time explaining in very close detail what the operation entailed; I signed the forms, giving my consent, and hoped for the best. I then had a visit from my anaesthetist, who spent an equally long time checking on any problems and concerns I might have; I asked how my teeth would be protected during the operation, when I had tubes going down my throat, and she said they could put a shield in place for me. 

After that, it was a slow wind-down to dinner: I had chicken, and boiled new potatoes, which was o.k., except that the potatoes were unpeeled... and a bit hard! Oh, dear, that's not how I like them! I had some ice cream, but again, it was quite a fancy brand of which I had never heard, and I would have much preferred a good old Walls choc ice instead. 

I had a signal for my phone, so I could use the WhatsApp facility to ring out, which made me feel connected - if I couldn't have visitors, at least I could talk! - and I also retrieved the art paper and pencils from my suitcase. I had a photo of a red admiral butterfly that had landed on one of Mum's sheets when it was hanging on the line to dry, so I tried drawing that; my coloured pencils were not really dark enough to get the deep red and orange colours I wanted to define the wings, but at least I think I got the shape of the butterfly. I worked on it until about 2.00 a.m., and it took my mind off what I had to be brave about and face up to, later that day.