If you've never had major surgery before there's the cool part after they've got you all scrubbed and prepped in pre-op, and inserted IVs in your veins, and you're ready to rock and roll with whatever's on the program. I'm familiar with this routine. It's the only part of the surgery your apt to remember. Then they start pumping fentanyl and versed (midazolam) into you and things get extremely pleasant instantly. You're riding a gurney, a rolling taxicab, through the maze of subterranean hospital hallways and everyone's wearing the same outfit: green scrubs with a big puffy beret, and there's a party going on exactly where you're headed: the room where they disassemble you and put you back together.
I was in for a minimally invasive cervical decompression on March 4. They were going to thread some arthoscopic instruments into the spaces around my neckbones - the cervical vertebrae - and grind down some bone spurs and fix some other crap that was pressing on my spinal cord and giving me grief. I was goofing with the anesthesiologists as I rolled into the OR, doing an old routine from a Samuel Beckett novel, Molloy, that I'd memorized back in college called The Story of the Stones ... "I took advantage of being at the seaside to lay in a store of sucking-stones. They were pebbles but I called them stones. Yes on this occasion I laid in a considerable store...." It's a great piece, goes on for pages and pages of absolutely absurd poetic drivel, and the chief anesthesiologist (Albany Med is a teaching hospital) was an Irishman like Beckett so I thought he'd appreciate it.
They'd just given me the final chemical push into dreamyland and inserted the breathing tube when the EKG unit that my heart was hooked up to started reporting strange activity. The waveform looked bad. My blood pressure shot way up. They stopped the operation. I don't know this on my own, but I'm told that as they yanked the breathing tube out I seamlessly resumed The Story of the Stones "...I distributed them equally among my four pockets and sucked them turn and turn about. This raised a problem which I first solved in the following way...."
In the commotion I assumed that that operation had concluded and all was well. I was then informed what actually happened, wheeled off to some post-op holding pen, and left to stew in drugged mystification and disappointment for a while. Eventually, they wheeled me up to a neurosurgery recovery ward to cool my jets until some new order of business was lined up.
The next two days I had heart tests. First was the common stress test. You get a dose of radioactive fluid, wait an hour watching Honey Boo Boo videos until it penetrates your tissues, and then get a set of fancy pictures of your heart taken under this big revolving drum of a camera. Then they put you on the treadmill to study how your heart performs under a controlled strain. Turned out the treadmill interface with the EKG was on the fritz, so they took me off and opted for the "hot-shot" instead. The hot shot is a dose of some chemical that fools your heart into thinking it had just run the 100 yard dash. Meanwhile you're hooked up to an EKG readout. It was like a chemically-induced anxiety attack. The EKG on me produced a strange wave form. The pictures, on the other hand, showed nothing conclusive.
The next day I went to the angiogram lab. It's a subterranean room chilled like a walk-in-fridge because all the computer equipment stuffed into it doesn't like to get warm. I got another IV "cocktail" down there while they shaved my groin and threaded a catheter wire into my femoral artery up toward my heart. There were at least eight technicians roistering around in there including the cardiologist who ran the lab. Some kind of Star Wars type of "music" filled the room, and the ambience was rather like a dance club around two o'clock in the morning, minus super-models. The upshot of the test was that I had a 90 percent blockage of the Left Main coronary artery, the "widow-maker." The other coronary vessels were clear.
It had to get fixed. The next step was to decide whether they would fix it with a stent or a bypass surgery. The stent is a little wire basket inserted with a catheter. They have two kinds: 1) plain; 2) coated with anti-clotting chemicals. It will hold a blocked artery open, but it has its limitations. You have to stay on blood-thinner drugs practically forever and the stent can just fail. The heart-surgeons and their cardiologist office-mates came around to talk it over with me and we all decided that a bypass was the way to go.
I spent the next six days as a hostage waiting for a surgery slot. The doctors didn't want to cut me loose because the widow-maker might take me out just lifting a bag of onions in the supermarket, and I suppose there were liability issues - like: this guy's heirs and assigns will sue us if we let him go for a few days and something happens. I had visitors, and my girlfriend kept me company for big chunks of the day, and I read a biography of Stalin - a much more interesting chap than I'd previously understood him to be - and, of course, I enjoyed the fabulous hospital cuisine. Oh, I wrote last week's blog somewhere in there, too, on my iPad.
Tuesday morning it was back to pre-op. This time, I didn't feel as frisky as the last when I performed Beckett. The anesthesiologist resident was a whip-smart Asian beauty with a jaunty head-rag and a droll sense of humor, and that was good enough. I don't even remember them shaving my chest, let alone sawing through my sternum and retracting the ribs to reveal all the marvelous pulsing wet gunk inside. The operation lasted about five hours. For about four of them, my heart was stopped and my lungs collapsed (on purpose, to get them out of the way). My blood and oxygen circulated through a machine. That was my "Kurzweil" moment. I don't remember dreaming up any avatar super-model sex partners in the process.
The surgeon "harvested" a couple of blood vessels from around my pectoral muscles to use as grafts. They used to go straight for the leg veins, but the chest veins are stronger and more flexible. They ran two bypasses around the blocked Left Main coronary vessel. The Left Main provides nourishment and oxygen for the whole left side of the heart, so you want to make sure that the bypasses deliver a lot of flow. They left three drainage hoses and a temporary pacemaker wire in my thoracic cavity, wired the sternum back together, and called it a day.
I came to, partially anyway, in the post-op with the breathing tube jammed in my craw and, quite possibly, the most unpleasant range of sensations I'd ever felt. A nurse or patient assistant sat nearby and I tried to communicate that the breathing tube was killing me, but he just said he couldn't understand me. So, I tried writing it out on my forearm with my index finger. He remained perplexed. Finally, I wrote it upside down and backwards, and he said, "Oh, 'gagging.' Yeah. Don't worry, it's normal."
The next 48 hours in the cardio intensive care unit amounted to a diminishing set of ghastly sensations. I was wired up to several machines and the hoses were dumping liters of accumulated fluid. Sleep was out of the question, such a racket of beeps and gurgling surrounded me. They got me sitting in a chair and then walking around the unit within a day of surgery. The other people on the ward were amazingly old, it seemed to me, pale, shriveled, grub-like creatures, like the nematodes you find digging up a patch of lawn. It was a stretch to imagine them surviving this.
The doctors came by now and again to check in with me. They mostly gave you the impression that they wanted to be somewhere else, and were impatient to get there. But since they came by in the evening, and still wore the scrubs they put on at seven in the morning, you got the feeling that they were horribly overworked, too. After two days in the ICU, they sent me upstairs for one more night, and then I came home.
The feeling of having been hit by a truck and then having had my brains pulled out of my head through my nostrils is beginning to dissipate. A few provisional conclusions. 1) I was lucky to find out I had a blocked artery in the way I did. 2) I was lucky to get it fixed, pronto. 3) Unlike many of my boomer friends in these later innings of life, I know exactly what the condition of my heart is now. 4.) I didn't have a heart attack at any point in the ordeal, and the muscle is actually quite strong, so I will be here to torment my adversaries and auditors for quite a while.
I now await the cavalcade of bills. It was impressive to see how hermetically sealed off the "care-givers" (doctors, nurses, etc) are from the business side of the hospital. At no point in the ordeal was the cost of anything discussed. Therefore, apart from the great benefit of staying alive, one is firmly in the grip of what amounts to an outrageous and indecent hostage racket. I'll keep you posted on how that unravels in the weeks ahead, when I'm not running my mouth in other directions.
Apart from that, too, I'm grateful to the doctors and nurses whose skills allowed me to stay on board the mystery train and see how Ben Bernanke's grand experiment works out, among other temporal melodramas. And thanks to many readers who sent emails of support and concern.
For a complete list of books by James Howard Kunstler and purchase links, CLICK HERE.