|Monday, 19 March 2012||On the Other Side of the Knife|
By Dr. Adrian Forrester
You’ll recall the film The Doctor starring William Hurt where a surgeon suddenly finds himself as a patient. That situation went through my mind when I found myself in the same boat. In the movie the central character finds the other doctors and staff treating him officiously and unsympathetically. I hoped that wouldn’t happen in my case.
It was eleven years ago and I was working at a hospital in the UK. The hospital was situated next to a zoo where the roar of the lion made me hanker for the game reserves back home. My wife and I had just passed the lion’s enclosure on our way to the restaurant when I felt a tight grip on my chest. I put my hand on my wife’s shoulder to hold her back, pretending to want to linger a little longer to view the big cats but I was as worried as hell about the sudden and awful feeling in my chest.
Classically, and worryingly, the pain eased. That’s a virtual diagnosis of angina pectoris. It means your life has changed forever. Perhaps substantially shortened. The mind does peculiar things in a situation like this, and possibly more so when you are a doctor.
I covered an aeon of time in nanoseconds. I was already on Lipitor for my high cholesterol. My father had died of a heart attack at about my age. What about my wife and kids, I thought, and the rest of my family, my friends? Is this the end now?
As we sat at the restaurant my mind raced over the possibility that the onion salad the day before had caused what I—vainly—hoped was heartburn. But my medical training told me this was angina and my life was at risk. I tried to put it out of my mind for one or two more days but its persistence reinforced my diagnosis and I informed my wife.
Medical practice in the UK is different to back home. In South Africa you go to a colleague and say, “I think I’ve got angina. Will you do an ECG and advise?” In the UK you’re supposed to have a GP (which I didn’t), book a visit with him and patiently wait for an appointment and hoping you won’t die in the interim. You could say to an associate, “Hey, this is very urgent. Could you see me straight away? I’m a doctor, etc.”
In the UK, GPs come from all parts of the world. I imagined the fellow would probably give me an antacid and try and reassure me in a foreign accent. Even if you go private, you are still expected to have a referral from a GP. Also I knew that several hundred cardiac patients died each year in the UK waiting for bypass surgery. So I wasn’t going to go down that route. I visited a hospital GP and persuaded him to get me an immediate appointment with a cardiologist. It’s amazing what you can do when you’re a doctor and you think your life is at stake.
Before seeing the cardiologist I had an ECG. It was mostly okay except for right at the end where it showed a slight glitch. A cardiologist saw me the next day. He was as friendly as an English cardiologist could be, and asked me if I knew a colleague of his in Cape Town (which I did) and he referred me for an urgent angiogram. I reflected that cardiograms, catheters and bypass surgery, as well as cholesterol-lowering drugs, were not on the menu during my father’s time.
Well, hope springs eternal. While I was having the angiogram, which I found pretty unpleasant, I prayed (not really) that I didn’t need an invasive procedure such as the insertion of a cardiac catheter or two. The upshot, anyway, was that the cardiologist told me I needed urgent quadruple bypass surgery. My circumflex artery was 99% blocked and the other coronary arteries weren’t much better. The ‘friendly’ insertion of catheters was out of the question. I burst out crying.
Some years previously I’d seen a physician in Cape Town complaining of extra heartbeats, known as extra systoles, which you feel as a fluttering sensation in your chest. A thing like that—the pumping of your heart when it misses beats—makes you realize—continuously—that you are indeed mortal. The doctor suggested a beta-blocker and told me I was fine. But here’s something to note. I did an effort ECG but didn’t complete it because I found it too strenuous. Big mistake.
What was happening was that my heart was not getting enough oxygen and the extra systoles were, in fact, a symptom of that condition. What the heart then does is gradually form small micro-vessels as a collateral circulation. This increases the oxygen flow to the heart and the extra heartbeats eventually stop. In any event, this was being wise after the event. To compound things I also suffered from GORD (gastro-oesophageal reflux disease) a common affliction in food-loving Westerners that gives you similar symptoms and, often, with strange feelings in your chest.
The cardiologist told me “the matter was in hand”. I’ll never forget the phrase—it was typical English understatement. I knew there was an excellent possibility I could drop down dead at any moment, but not to worry, “the matter was in hand”. He referred me to an affable Hong Kong-born but British-trained Chinese cardio-thoracic surgeon. Luckily (!) for me, the hospital happened to be a centre of excellence as far as heart diseases were concerned. I asked if I could fly home and have my heart surgery in familiar surroundings but was told, in effect, that I was too ill and that I must “potter around” until they found an open slot for me. More understatement. There I could be “pottering around”, watering pot plants and things, with “the matter in hand”, and I could croak at any moment.
I was told I would probably be operated on “within ten days”. I considered my mortality. I didn’t have some demon eating away at vital parts of my body. My problem was one of only “blockage”, a defect in the plumbing. Everything else was A1. It was unconscionable that one should die from such a minor impediment. My visit to the cardio-thoracic surgeon and my subsequent and on-going musings all took place on a Friday. That night I get a call from the surgeon: “You’re in luck. I can do you tomorrow. Don’t eat anything and admit yourself to the ward now. Okay?” I felt as if I’d been hit by a truck. It was a sensation I will never forget. I had been psyching myself up for an operation in 10 days’ time and this was only Day One. I said yes, thanks and good-bye, and then burst out crying again, like I’d never done in my life. Tomorrow they are going to split open my chest as if I were a chicken and stop my heart. Why wasn’t I on a beach in Mauritius asking for more litchis and another chocolate milkshake? I had other stupid thoughts: I’d probably never see what the next 7-series BMWs or S-class Mercs would look like. I thought of writing a letter to my three children in case I didn’t make it but then decided it would be a mournful document anyway. They would have to just rely on an upbringing that showed them I loved them dearly.
I told my wife that if push comes to shove she should get married again and not be a widow of 50 years like her grandmother. And to enjoy the insurance.
I was well and truly premedicated and sedated and didn’t remember that first night in hospital and I have just a fleeting memory of going into theatre. Besides the enormous amount of training and ability required, open heart surgery it is lengthy and physically laborious. As it is, it took them an hour to start my heart again after the bypass had been done. Imagine the disappointment of the doctors after doing all that work and not getting the heart going—all that work for nothing. My disappointment, though, would have been greater.
I had several units of blood and took many hours to come round. The breathlessness after the operation was very debilitating. This was due to my low haemoglobin after my blood loss. Going to the loo was like climbing Mount Everest. All the contraptions in the cardiac ward and around the patient’s bed were made with Mike Tyson in mind. I had a blood transfusion and felt much better a few days after this. I loved my surgeon with his bespoke suits and I remember his flat abdomen (not in that way!) and his smart belts. I decided to get myself a flat abdomen and buy some belts. Today I have the belts but am still working on the flat abdomen.
Well, all’s well that ends well. Besides crying inappropriately—which is normal after this type of surgery—while watching documentaries on Elvis and Yuri Gargarin, I made an eventful recovery and became well-established as a hypochondriac of note. It’s over a decade now and a recent angiogram showed all harvested arteries up and running. In passing, I might as well mention I can’t now afford the 7-series or S-Class, but what are they compared to life?