- © 2007 Canadian Medical Association or its licensors
On May 20, 2006, I was rushed to hospital in acute congestive heart failure. I had ruptured a chord of my mitral valve. Without open-heart surgery, I would probably die in less than 10 years. I was a nurse working at a children's hospital.
I read and reread my discharge summary and the angiogram results to confirm that what had happened to me was real. Gingerly I searched the Internet beginning with the term “mitral valve prolapse,” “ruptured chord,” “flash pulmonary edema,” “mitral valve repair” and finally “life expectancy after mitral valve repair.”
I sat in my garden in my bathrobe and contemplated. I drew comfort from the sun, flowers and foliage. Even the neighbourhood cat climbed into my lap to comfort me.
There was so much to do. I had 2 weeks to prepare for surgery. My husband, Robert, and I planted all my seedlings into containers. I surrounded myself with positive images. I watched movies like Gladiator, Hero and Spiderman — stories about heroes overcoming adversity (the bigger the adversity the better). I also began to write this story. I didn't want to forget and I was searching for meaning.
I helped my son pack for his first trip to Europe. He was so anxious. I watched my 14-year-old daughter and saw what a beautiful, strong, helpful, young woman she was becoming. I felt so proud. I went shopping and walked among the crowd but felt like I didn't belong. I was preoccupied. I took a bus alone and felt anxious, I didn't like feeling vulnerable. But despite my physical limitations, I drew strength from my writing and my surroundings. I grew stronger each day. Deep down I felt content. I was at peace.
Robert and I met the cardiac surgeon. The surgeon would need to see the damaged valve with his own eyes to determine whether the valve could be repaired or needed to be replaced. Repair and replacement held different outcomes. Valve replacement meant taking blood thinners for the rest of my life and a higher chance of a reoperation. The surgeon also showed us a sample of the ring used during valve repair. At the end of the operation, he would test the valve and know immediately how successful the operation was. He explained the possible complications — death (unlikely), air embolism, stroke and bleeding.
Robert and I prepared our wills and talked briefly about funeral arrangements. The day before the operation, I received phone calls from colleagues and friends all wishing me luck. I felt strong and confident — buoyed by all the support.
On the morning of the operation, Robert drove me to the hospital. I toured my garden before getting into the car. While we drove, I was trying to drink in all the images and burn them into my memory. The city is peaceful early in the morning. I could hear Louis Armstrong sing “What a wonderful world.” I felt like a lamb going to slaughter.
I was admitted into hospital but didn't want to change my clothes until I absolutely had to. I took my final shower, put on a hospital gown and said good-bye to Robert before climbing onto the stretcher. My hair was covered, and I was wheeled into the operating room. I saw the heart–lung machine. My arms were removed from the hospital gown and placed onto arm splints. I felt like Jesus Christ being nailed onto the cross.
My memory is hazy after that — there are many gaps. I remember waking up in the intensive care unit (ICU) and feeling like I had been hit by a 20-ton truck. I remember the pain, the fatigue, the tube in my throat, the panic and the nausea. I remember voices and Robert stroking my forehead. I remember the tube being removed from my throat. I remember asking the surgeon what type of operation he performed and his response “quadrangular posterior leaflet resection.” For 2 days I drifted in and out of consciousness. I remember a nurse asking me what day it was and my being confused.
On the second day post-op, I was moved onto the surgical unit and given fluids to drink. The physiotherapist gave me an inspirometer and I practised deep breathing and walking. I was exhausted. I didn't have the strength to eat or practise deep breathing. My oxygen saturation dipped into the low 90s without oxygen. Robert was worried and frustrated at my lack of effort and progress.
On the third day post-op, the nurse gave meticulous care and made me incredibly comfortable. My blood pressure was low (85/54), but the surgeon ordered me out of bed. The resident and nurse removed my chest tubes and I was left with 2 gaping holes that looked like bullet wounds on my belly. When the physiotherapist came, I stuffed my swollen feet into my sandals and stood up. I used the walker to walk down the hallway but was forced to sit down because I felt dizzy and was suddenly out of breath. My hemoglobin was low (79, normal is above 120) as a result of post-op bleeding. I did not know the extent of my blood loss until then.
Robert told me that on the day of my operation, I experienced post-op bleeding. I lost 100 mL of blood within 5 minutes and the surgeon ordered 2 units of packed red cells. In all I received 15 transfusions in the ICU immediately post-op (3 units packed red cells and 12 units of fresh frozen plasma) and another 2 units packed red cells on the third day post-op for a total of 17. It was mind-blowing to imagine that my entire blood supply had nearly been replaced. I had the blood of 17 different people coursing through my veins. This was not anticipated nor had I prepared myself to be the recipient of the “gift of life.” I became concerned about the safety of the blood donation system. Several medical experts have since reassured me that the blood that I received was infection free. I know that I did not have a choice. Reflecting back, I would have chosen to live.
I improved steadily after the transfusion. I could stay awake and hold a conversation. I read and received visitors. I forced myself to eat, to walk and to do my deep breathing and coughing. I was given diuretics and lost the 10 lb of fluids that had accumulated after the operation. My hands and Hobbit feet shrank back to normal size. I had ankles again.
On the day of my discharge, I had another echocardiogram. The cardiologist reviewed the results with me — I had only trace mitral regurgitation and the annuloplasty ring that was sewn into my heart was well positioned. The doctor reminded me about short-term pain for long-term gain. The operation was a success! My heart was no longer drifting but it was limping along. The surgery had been much tougher than I had imagined. I thanked my surgeon, from the heart.
Footnotes
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“From the heart” is an excerpt from The drifting heart, (unpublished manuscript), written by Lily Chin-Peuckert.