[I will try not to be particularly graphic, but we are discussing surgery here, so be warned.]
The drugs didn't work. After weeks in the hospital, the bacterial vegetation1 was on my heart, in a place where it could seed the rest of my body with little bacterial colonies, but in a place where intraveneous antibiotics had trouble reaching it effectively. The vegetation was on the right side of my heart2, what is technically the pulmonary valve, the valve separating the pulmonary artery and the rght ventricle of the heart. This is problematic not only because, in general, bacterial vegetation on the heart is bad, but also because a) it was a virulent staph infection with a higher probability of metastisizing (that is, spreading to other parts of the body), and b) right-sided infective endocarditis is almost solely found in intravenous drug abusers. I had the type of disease that heroin addicts get.
1This is not my term; it's the doctors'. Apparently the bacteria sets up a little colony or a forest with supplies and everything. You can see
pictures of what it looks like at the Wikipedia page, if you want to, but they're not particularly pleasant.
2Make a fist with you left hand so the palm is facing you. The right atrium is your thumb. The pulmonary valve is right where your index finger hits your palm.
My primary doctors thankfully believed me when I told them that I had never injected a drug into my body in my life, but a resident or two kept bugging me, repeatedly asking me how often I abused heroin, and even one time, where were my track marks? Thankfully, this never got in the way of requests for morphine, but it had the possibility of making them problematic. I only realized later that part of the reason they weren't making a big deal about my requests for opiates might have been that they weren't entirely expecting me to survive. Infective endocarditis is a nasty disease. On average, the disease has a 25% mortality rate: one in four people who get the disease die of it. I heard various numbers on my own chances: the two numbers that stick out most in my memory were that I had a 40% chance of making it, and that if I'd waited another week before coming into the hospital, they estimated my chances would have been about 5%. So getting addicted to morphine wasn't really my biggest problem.
Regardless of my statistical chances, the regimen of antibiotics wasn't cutting down the vegetation. Infected fluid had been removed from my lungs, an abscess on my ass, and from the sac around my heart, but despite being in the middle of the heart, heart valves are not supplied by blood vessels and are resistant to IV drugs. The decision was made that I needed open heart surgery to remove the vegetation; once the vegetation had been removed from my heart, the antibiotics would be enough to handle the outposts throughout my body and I would be able to heal properly.
So. Open heart surgery it would be. My surgery would entail:
- my being anesthetized
- opened up
- my ribs clipped and temporarily moved aside
- my lung deflated to make getting at the heart easier--a machine would do my breathing for me until the surgery was over
- the bacterial vegetation essentially scraped off of the pulmonary valve...
- ...and, if necessary, the tricuspid valve being removed entirely and replaced with the valve of a pig
- My ribs being put back into place and tied back up with steel wire to hold them in place until my bones knit back together
- And then they'd close me up, take out the breathing tube, and eventually wake me back up.
The surgery was described in even more detail to me, but all I could think of was, "A pig's heart? I won't be kosher." I'm not Jewish.
I was scheduled for a Thursday morning surgery. 8am. Since I was in the hospital, I wasn't going anywhere and I didn't have any other commitments, so my schedule was pretty easy to clean out. They stopped feeding me the night before, and stopped giving me water at midnight, to make sure my stomach was empty so I wouldn't get naseous on the anasthesia. This was standard for pretty much every major test they gave me while I was in the hospital. It's not particularly difficult to go without eating the night before your surgery; the idea of being cut open is a pretty effective way to sap your appetite. Occasionally I'd think about having something to eat so they'd have to cancel the surgery, but that's a pretty immature way to deal with these things--also, doctors tend not to assign open heart surgery unnecessarily, so making an effort to duck out on it isn't all that smart.
The morning came. The surgeons came into my hospital room to see me. Within two minutes of talking to me, he decided that I was too weak to handle the surgery properly, and as I was not in imminent danger, he advised me to work on regaining some of my strength before they'd attempt the surgery again. It was a relief not to have to go through the surgery that morning, but "You're not strong enough to survive this surgery" isn't the greatest thing to hear.
As it was, the day came ten days later. I was told that without it, I would die. Whether I'd had enough time to regain my strength or not, they wanted to clear out the vegetation before any more chunks of it broke off and went roaming through my body for a place to breed. So I went through the same thing again. No food or water the night before. The doctors came in and saw me. They said it needed to be done. I said I was scared of the surgery.
The head surgeon asked, "Have you ever seen Butch Cassidy and the Sundance Kid?"
"Of course."
"Right now you're afraid because you can't swim. Do you remember how Butch responded to that?" the surgeon asked.
"'Are you crazy? The fall will probably kill you!'"
We both chuckled. This anecdote is a little more disturbing in retrospect than it was at the time, but his point was clear. I was worried about the wrong thing: rather than being afraid of the surgery, I should be afraid of the bacteria inside of me. Do what needed to be done, and worry about the next step after that. I just wish he hadn't used a quote with the word "kill" in it.
I was going in. I emailed my girlfriend right before. She was in the room with me, but I wanted it in writing:
If anything goes wrong, take my money. It'll support you for awhile and help pay rent. It's a pedestrian matter, but it should go to you.
No heroic measures, please. I don't want to be another Schiavo.
Remember that I love you so much. Please.
Love,
Stu
And I was wheeled down to anasthesia.
And that was it for about six hours, as far as I knew.
The surgery went quite well, as far as surgeries go. Everything went according to plan. There were no complications. The bacterial vegetation was scraped off, the valve was undamaged, and they didn't have to make me traif.
Unsurprisingly, waking up from surgery is remarkably unpleasant. There is a little time where they let you be unconscious, but it's policy to wake you up as quickly as possible and keep you awake. The patient is woken up, and once they have consciousness to breathe on their own, the breathing tube is removed. Thankfully, this was done on me before I woke up enough, so I have no memory of this indubitably uncomfortable process. I was wheeled onto the CT-ICU3. Every nurse and doctor on the ward came into my room and yelled at me. In the interest of keeping the patient awake (so they don't pass out from the anasthesia still in their lungs), everyone available comes to the bedside and makes as much of a distracting noise as possible. For the only time in the hospital, people stopped calling me "Mr. Stuart" and yelled my first name at me. They only stopped when my girlfriend told them all that I respond more to "Stu" and they should yell that instead. They'd yell "Stu!" and I'd wag my head at them, and then my head would droop again, and someone else would yell, "Hey Stu!" and I'd perk up again. They didn't try to talk with me, just yelled my name.
3Cardio-Thoracic Intensive Care Unit. The special ICU for heart and lung patients.
The yelling went on for probably fifteen minutes. It was mid-afternoon, and I was more tired than I've ever felt before. Not only was there still anesthesia still working on me, but I'd been up most of the night worrying about the operation. They needed me to stay awake for at least three hours after that point, until the anesthesia was out of my lungs completely and I would no longer be in danger of...I'm not exactly sure, actually. They just told me I needed to stay awake, like someone with a concussion in a movie. So after some yelling, I was awake enough to converse, and they let my girlfriend sit down with me and talk to me to keep me up.
I was desperately thirsty. I was not allowed to drink at all, at first. The worry is that my stomach would be upset and that I would have to throw up, and throwing up would be a very bad thing in my condition. After an hour of being up, I was allowed a glass of ice chunks, which I could suck on one at a time. They helped with the thirst, but not a lot. I wouldn't get to drink an actual glass of water until nighttime, and even then, the worst nurse in the world would yell at me for what little water I drank. I'm not going to talk about her beyond this, but it was a bad night and she is the only person in the last two decades who has ever made me cry; I wish nothing but pain upon her.
The incision essentially looks like a zipper. It goes down to the bottom of my sternum, where there is something like a divot and a lateral mark about the length of my little finger. It looks like an upside down cross with a really small crossbar. This is now a scar; at the time it was covered in bandages and a foul brown smelling disinfectant, some variation of iodine whose name I kept asking about and forgetting everytime I got a fresh hit of morphine--one milligram every eight minutes, upon request.
I had a central venous catheter: essentially, a souped-up IV inserted directly into the jugular vein used to mainline medication into me. I had a catheter. I had a tube draining fluid from the operation site in my heart. I had an arterial line in my arm, for more intravenous medication and testing. And I had two wires stuck into my chest: these wires were essentially jumper cables physically touching the surface of my heart: in the event that I had a heart attack, these lines would both set off alarms for emergency personnel to come to my aid and give a direct shock to my heart to jump it back to life. They'd remove these cables piece by piece over the course of my week in the CT-ICU. The painkillers would give me the worst constipation of my life. It'd take me over a week before I'd be able to take a step again. I still don't walk without a cane. A full recovery is expected.
How does a resurrection really feel? Pretty fucking uncomfortable.
But it's better than the alternative.
