Open-Hearted - Part II

December 6, 2021

“What’s your name…Do you know where you are?” If they didn’t know, I was in trouble. Where was the gratitude I expected to feel when I woke, alive, from open-heart surgery? Bewildered at being asked to engage in a drug-infused conversation, I mumbled confused replies in a pained whisper. I couldn’t take a deep breath. I don’t remember my partner Laura’s afternoon visit. 

In the ICU, not only does time not fly, it does not move. Changing positions my first night was impossible with an IV in my hand, a main port with tubes dangling from my neck for middle of the night blood draws, and I would later learn, a tiny camera monitoring my heart through a neck incision. Other monitors covered my chest and abdomen as a catheter collected urine. I couldn’t roll over to press the call button, since I needed help rolling over. Desperate for sleep between blood labs, electrolyte drips to help the blood thinner reach a required level so I wouldn’t have a stroke, and compression cuffs around my lower legs to keep my blood circulating so I wouldn’t have a stroke, I watched the clock crawl toward midnight. I dreamed in snippets until a nurse shined a light in my eyes, as she had every hour, to make sure I hadn’t had a stroke. When she left, I wondered how long I’d slept. One hour? Two? I looked expectantly up at the clock. I had dozed for ten minutes.

Hours later, the nurse pricked my finger for a blood drop, following up with a shot of insulin. I asked her why. “The sugar water we float your heart in after we stop it is absorbed…” I closed my eyes and tuned the rest out. 

My surgeon likes to see his patients sitting up, and I complied on my first post-surgery morning, my drugged head bobbing forward and back, in retrospect not a bad exercise after being stretched out as if on a crucifix for a good part of the day. After teetering in my vinyl, easy to clean recliner chair for a few hours, a PA helped me to lie back on the bed. “Damn, who tied these so tightly?” she asked, pressing a small pair of scissors into stitches in two sites in my upper abdomen. I told her I had no idea, as I had been unconscious. She finally got me unstitched and pulled out two long drainage tubes. I only know this because she told me, not because I’d asked. Certainly not because I’d watched. I’m not that type – I’m too squeamish. If you’re gonna stop my heart and lungs and replace my heart’s mitral valve with a pig’s valve, I’m better off without a visual, without specific details. 

I used to wonder how it would be to have a near-death experience from a car accident or a slip in the shower. Would I reflect on my life and move forward with renewed appreciation? The day after this surgery, a doctor asked, “Do you feel like you’ve been hit by a truck?” I did, but before I could see the gift in it, I had to survive.

On day two, Laura arrived with Jay, who, in a reversal of long-ago roles, coaxed applesauce into my dry mouth with a plastic spoon. This sweet, fleeting offering, a singular moment in time, was one reason I ate, the other being that I wanted to show my son that I intended to stay alive. When they left, my nurse suggested I order my meals using a phone I hadn’t known I had. Holding it, I had no clue how to call the kitchen. I spent hours – or maybe minutes – staring at a cup of water and a tiny can of ginger ale on a tray six inches beyond my outstretched arm. I'm not sure how long I stayed in that position. I do recall doing some imaginary math to figure out how many thousands of these cans were distributed each day,  hoping the hospital recycled. I had been warned to use my arms minimally, so even if I reached the tray, I wasn’t allowed to pull or push it. “What are the four sternal precautions?” my young OT had asked after reciting them once, loudly, as if I were hard of hearing. I answered hesitantly, because I could barely remember. Also, the breathing tube had scratched my throat, and the tissues around my heart and lungs were still inflamed, so it hurt to talk. 

1. No hands over my head

2. No lifting, pulling, or pushing anything over five pounds - a gallon of milk weighs eight pounds

3. Only one hand behind me at a time 

4. (I couldn’t remember the fourth, except that it suggested putting out of my mind the fact that I had arms)

That afternoon, feeling as stable as Oz’s scarecrow, I took a slow-motion walk with my nurse. I got as far as my hospital room entry and turned back, winded. Was this my real life? That evening I went into AFib, or atrial fibrillation, meaning I developed an irregular heartbeat. My surgeon visited often, and in my oxycodone haze, I argued politics with him. He had been a sniper scout in the Arab-Israeli War in the late 1940’s, and was not, he said, a Noam Chomsky fan. I told him this didn’t surprise me, and pointed out, I suppose as a retort, how curious it was that he – the surgeon – had been liable for a number of deaths, and was now saving lives. He offered good- naturedly that those of us in the U.S. who haven’t lived in a war-torn country and experienced suffering first hand, should do so for a few years, to expand our point of view. I decided it was wise to end the debate, since he hadn’t yet finished saving my life. With a welcome change of subject, he voiced puzzlement at my AFib, since he “had removed a useless heart appendage that should have prevented it.” Uh huh.

Just before dinner, another PA helped my nurse get me back into bed. More stubborn stitch removal, and a long, thick gauge pacer wire emerged from my abdomen. I asked what else was in there, hoping this was the end of that treasure hunt. I’d slept on a soft pillow the first two nights, not knowing that Laura had wrapped her down jacket inside a hospital pillowcase during her first visit. This time she brought my pillow from home, in a case printed with a dog park scene. Both pillows were, as I think back, my security blankets, grounding me when my surroundings – lights and beeps, bed, johnny, my own body, my sense of sanity – felt unfamiliar and elusive.  

Time remained illusory. By day four I was feeling invisible, abandoned, with bouts of paranoia from sleep deprivation. Every once in a while a puff of anesthesia pushed itself from my lungs and out between my lips. Better out than in.

A strong core is vital to muscle control, injury prevention and basic life activities. A strong core is also vital, I quickly learned, to rocking armless-ly back and forth to get your feet to the floor to totter to the bathroom, to the vinyl chair, to walk the ICU with a nurse. Each day I improved slightly. Despite my cardiologist’s forecast of two days in ICU, then three in a regular hospital room, I was released on day nine. 

At my two-week post-op checkup, my surgeon – Dr. B – played for Laura and me a life-sized video of my first echocardiogram. “See here, these two parts of the valve, like parachute wings, were not meeting after each beat. See the blood leaking out at the top? Your leak was severe. Now this is the post-op echo.” Watching my heart beat again on the screen was akin to a horror movie. “See here how the new valve closes nicely after the beat?” Uh huh. “And look here at the wires holding the two halves of your sternum together.” I heard myself say, “Note to self: Faint later.” Dr. B laughed. I gripped my chair’s arms, breathing, trying not to have a stroke.  

As a grand finale, he unscrewed a small jar. I prayed he was about to share left over applesauce from lunch. “Look, this is a pig valve just like your new one.  Go ahead, touch it. That orange plastic piece comes off before we put it in.” The orange part looked much like a Lego my grandson Declan might use to build a structure. It was grounding, something I could imagine as familiar. I touched the valve lightly. Poor pig. Or was it? Apparently it had been living its life with a stronger heart valve than the one I’d been going about my business with. “A pig gave its life for me” is a sentence I never thought I’d utter, but when I did, I sent a mental note of thanks.

Walking our neighborhood block, Laura held two dog leashes, while I cautiously navigated undulating tree roots and asphalt swells. When I imagined tripping, my hand flew up to protect my healing wound and sternum. Bundled up and shuffling forward in a long hooded coat, I must have looked like a drugged up relative on furlough from an institution. After eight nights in ICU, this wasn’t far from the truth.

April 6, 2022

At four weeks post-surgery, a cardioversion (shock to the heart) failed to return my heart to normal sinus rhythm. Now, three months after that, I’m still on AFib meds, curious about whether, and how, I might be weaned off. Will I take blood thinners requiring blood draws for the rest of my life? These questions aside, after spending my energy staying alive, I’m finally feeling surges of that elusive gratitude at simply being alive. 

Now for the big reveal, which isn’t really so big. Before my surgery, as I wrote in Part I, I wrote Noam to ask his blessing for my book project. I wanted a simple quote to share with publishers and agents wanting his approval. His reply was exactly the reply I’d expected. He said it was not up to him to decide whether I should be writing the book, but that it was up to me. He said he trusted Jay Keyser’s good judgment. 

Reflecting on this, I realized that if I hadn’t known for sure he would answer the way he did, I had no business writing this book. It is, after all, about my reading between his lines, about our silent communications, and what he called my “uncanny” intuition and tact handling visitors and crews worldwide. It is about the mutual trust we’d built during our years together. Of course he would trust my rendering. 

As of today, I’m waiting to hear from a NY publisher about whether he will take me on. If he says no, I’ll keep moving forward, because I’m here, and I can.  I just wish Laura would stop making pig jokes. It’s too soon.