Bright lights & needles: Greeting the day in cardiac care

With my heart problem diagnosed, I spent a week being prepared for surgery. The doctors took care of my physical body. But I had to take care of my mind.

This post is about the physical preparation for Coronary Artery Bypass Graft (CABG).

Coming to terms with a diseased heart

St John of God Hospital (SJOG) in Murdoch is a private hospital in the southern suburbs of Perth in Western Australia,  It has the best coronary care unit (CCU) staff and facilities imaginable making it the perfect place for intense introspection and profound emotion.

It was like a health retreat but with therapeutic drugs, medical tests, endless needles … and no yoga.

My room was enormous. Bigger than an average hotel room. The bathroom was perfect for my low blood pressure moments; the handrails and other modifications were handy.

Routine

Each day took me closer to the day of surgery which I dreaded but wanted to be over.

For 6 days, this was my experience:

6:00 am          Bright lights flicked on. Wake up from stupor.

6:10 am          Have cannula changed (if needed), have much blood extracted for tests

6:45 am          Breakfast. When I could, I would get out of bed to eat.

The rest of the day:

  • Showering (no mean feat with the ever-present heart monitor, cannulas and IV drip)
  • Reading Australian Heart Foundation brochures (see what I thought about them here)
  • Reading trashy magazines and my novel
  • Talking to nurses and asking hundreds of questions
  • Crying
  • Staring out of the window
  • Having another iron or electrolyte IV infusion
  • Visits from my sister
  • Having heart checks and tests
  • Wondering about the size and colour of my haematoma after the angiogram
  • Reading emails and texts from friends and family
  • More crying
  • Snoozing
  • Meandering around the cardiac care ward and into ICU
  • Writing notes about my feelings
  • A bit more crying
  • Asking over and over, “WHY ME?”

5:30 pm          Dinner

6:00 pm          Visits from my cardiothoracic surgeon, cardiologist and my husband

7:00 pm          Staring at the TV, talking with evening shift nurses and visitors

9:00 pm          Lights out. Visitors leave

9:30 pm          Sleep 

This was my room in the Coronary Care Unit.

The Heart Source

Physical Preparation for Heart Surgery

In the emergency department, I’d been given a blood thinner called clopadogaril. All traces of that drug had to be completely out of my body first, that’s why I couldn’t have surgery straight away.

I had more IV infusions of electrolytes and iron. They tested my blood every day. I suspect I was being optimised for surgery.

Feeling like a sacrificial lamb right here.

Heart Imaging

The heart surgeon doesn’t want any surprises during the operation, so my heart was examined for structure and function beforehand.

I had a transthoracic echocardiogram. This is not so bad – no discomfort, no need for needles or x-rays. It’s just an ultrasound of your heart. You lie on your side while it’s done and you can see your heart working! You see the heart chambers, valves, heart size and blood flow. It’s specky! If you ever get a chance to see one, it’s quite amazing.

I had a healthily functioning heart.

Two important large blood vessels (carotid arteries) take blood from the heart to the brain. If these are clogged with plaque, then blood flow to the brain is reduced. The plaques can rupture or break off and cause a stroke. I had a carotid echo Doppler. It’s another painless ultrasound.

My carotid arteries were fine.

Heart Monitoring (Telemetry)

From the moment I entered the Emergency Department until 17 days later when I left hospital, my heart activity was on display somewhere.

I wore a telemetry unit. Everywhere. All the time. Even in the shower.

Here’s a little background on these nifty devices:

  • Electrical leads are clipped to spongy tabs attached to specific points on your torso
  • They monitor heart electrical activity, pulse and blood pressure
  • While similar to an ECG, they do not work the same way (they have fewer leads)
  • Information is transmitted and displayed onto screens in the nurses’ office
  • If something goes wrong, an alarm goes off

Heart telemetry

I learnt quite a lot about my heart telemetry unit:

  • How long the battery lasted (nearly 2 days)
  • The low battery alarm
  • The alarm that sounds when a lead detaches
  • How to identify which lead detached and where to re-attach it
  • To wear tops with deep (and preferably inner) pockets so the unit could be carried more comfortably

The only time I was disconnected from the telemetry unit was on my wedding anniversary.

I was allowed to leave the CCU for 30 minutes. I went to a café in the hospital for a cup of tea with my husband.

I’m not kidding when I say I felt very vulnerable without it. Quite scared. My blood pressure was low, I felt woozy and nobody was monitoring me.

It’s terrifying to think that only a week previously I was living a regular, unmonitored life with a heart time bomb in my chest.

Skin preparation for surgery

For 4 days before my operation, I used a skin sanitiser called chlorhexidine in the shower instead of normal soap. This was to reduce the number of bacteria living on my skin to minimise any risk of infection. When I started to use the chlorhexidine, Operation Day was even closer.

Chlorhexidine

Non-physical Preparation

Emotional and mental preparation for heart surgery is immense.

You can Google many things, but you can’t Google an experience

My mental preparations for heart surgery deserve a separate blog post.

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… More references on heart health tests and conditions:

  1. Echocardiogram

An explanation of the procedure for patients

https://www.nlm.nih.gov/medlineplus/ency/article/003869.htm

  1. Carotid artery disease

Carotid Artery Disease: Causes, Symptoms, Tests, and Treatment

http://www.webmd.com/heart-disease/carotid-artery-disease-causes-symptoms-tests-and-treatment?page=2

Explore Carotid Artery Disease

http://www.nhlbi.nih.gov/health/health-topics/topics/catd/

Atherosclerotic Disease of the Carotid Artery

http://emedicine.medscape.com/article/463147-overview

  1. Doppler Ultrasound

Detailed explanation of this procedure and its different applications

http://www.webmd.com/dvt/doppler-ultrasound

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