The Cardiac Close Call
or
How Bob Was Saved by Angina Pectoris

📆 Show Recovery Calendar

The Event

One weekend day in mid-January, while vigorously sweeping out my new barn, I began to feel short of breath.  I stopped for a moment and felt a slight squeezing in my chest, a feeling lighter than that of a baby gripping your finger, along with a little tingling in both arms.  Recognizing this as a possibly dangerous symptom, I stopped sweeping, returned to the house, reported the feeling to my wife and told her I was going to rest for a while.  Ann Marie said, “You should call your doctor tomorrow.”  I agreed.

Because of my status as a person with AIDS (PWAIDS, a truly ugly acronym) I am normally very good about calling my doctor and reporting my concerns, but the last year or so work has been consuming my life, so I waited over a week and a half before I called him.  He suggested a stress test at Beth Israel, soI called and scheduled it for February 14th, the first available opening for non-emergency cases.

As a side note, work was interfering with normal life so much that I had sought a medical leave of absence last year.  The Broad spire disability management company that my employer was using, and who pride themselves on cost-effective loss control, denied the leave because my “clinical record does not indicate the need”.  Never mind that my doctor thought it necessary, or that I had been granted leaves twice in the previous ten years that were effective in identifying underlying problems for treatment and restoring my vigor.  That outsourcer has since been replaced by my employer, but the denial stood upon appeal, and I have yet to file the final appeal.  I think, actually hope, that the determination might change based on current events and I will be paid for the time I took off (but not the aggravation of fighting the denial).  Farmer Bob will be writing more about this issue of disability cost control in his blog, when he gets the time.

TheDiagnosis

The Stress Test

So, on Tuesday, February the 14th, I went for the stress test. Soon after, I forget which day, my doctor called and said that he had some concern about the “shape” of my EKG and thought I should see a cardiologist for a definitive diagnosis.  Because of the constraints and responsibilities of my work and the availability of the cardiologist, I was unable to have that visit until March 9th. That day the cardiologist did the usual inter view the patient, listen to the heart, check the pulses routine and said he was going to review the EKG and my other records and would return momentarily.  He returned shortly afterward, told me that what I had experienced was a “cardiac event calledAngina”.  He said he would give me a prescription for Toprol XL and nitroglycerin tablets and explained that both were prophylaxis for Angina. In an almost comical exchange, he asked if I worked out.  I told him no.  He then said, “Then why are your arms so strong and your upper body so defined? What kind of work do you do?”  I said “Typing, traveling, thinking and talking on the phone. I do play a lot ofGolf, daily if possible, and I practice swinging a golf club extensively, and hit a lot of balls at the range whenever possible.”  He said that the exercise served me well, and that I should continue to work and to play, but to take the nitro before any special exertion like sweeping the barn or walking up the hill to the 3rd hole at the Shattuck.  He also recommended the “gold standard” diagnostic procedure of a cardiac catheterization and angiogram, explained the risks and the possible benefit of being able to do an angioplasty and place stents if they found any blockages.  He explained that if stents were placed I would be staying in the hospital overnight, but that it was otherwise an outpatient procedure. So, being a compliant patient who defers to competent authority, I agreed to the catheterization and we set it up forTuesday, March the 14th.  I was a bit apprehensive about the procedure, especially when the cardiologist mentioned the 1 in 300 risk of death or serious complications, and the more common risks of bruising, bleeding, etc.,but I steeled myself that it was most necessary and the best course of action.  I was also heartened by the cardiologist’s comment that I was young and strong and should come through it just fine.  

The Catheterization and Angiogram

Because the catheterization was scheduled for early morning (6:45) at the Beth Israel Deaconess Medical Center(BIDMC), I went down to Boston on Monday night and stayed with my good friendsFreddie and Kazue.  Another old friend,MLD, brought me to the hospital the next morning.  I was prepped for the procedure and it started around 7:30.  I was awake for most of it, felt the catheter being inserted and the heat of the dye injection.  They said I’d feel hot or burning all over, but the heat was mostly centered in my chest and I felt cozy throughout the rest of my body, and I told them so.  I’m a little hazy about what happened next asI fell asleep under the influence of those wonderful drugs they use to make you comfortable enough to allow strange objects to wend through your arteries.  I awoke in the recovery room to a doctor who said, “We have good news and bad news.” The good news was that the procedure went swimmingly, without any complications.  The bad news was that they found blockages in places where they could not use angioplasty and stents safely and that I would need Cardiac Bypass surgery.  They explained that the heart has three major supply vessels, and that I had a variant but common heart type that consisted of two good supply lines and one almost vestigial one or, as I now explain it, two interstates and a dirt road.  The two good supply lines were blocked; one 85%, the other 65%.

I said, “OK, let’s schedule the surgery.  I have some customer meetings next week, and some other stuff to catch up on, so when can we get me in?”

The doctor said, “I don’t think you understand, Mr. Kelly.  Yes, you can postpone this surgery, but that could mean that your first heart attack may be your last.  We would like you to come in next week, probably Monday.  The surgeon and anesthesiologist will be dropping by to explain things and ask you some questions”

“OK”, I said, “I get the picture.  Let’s get it done.” I lay on the gurney preparing myself psychologically for my first major surgery and the fact that my first broken bone would be done by a professional using power tools.  I called my wife who, as planned, had been waiting at home for a call from me about whether I would be staying overnight or released the same day.

My surgeon came by and explained the surgery and risks, and told me he expected it to go well because I was young and strong.  I told him that my Mom had a bypass and always complained bitterly about the leg incision.  The surgeon said that they were using a new procedure to obtain those blood vessels, and that only small incisions would be made at the top and bottom of the vessel and it would be pulled out much like a straw from its wrapper.   This was most heartening, and, since I had been feeling old and weak for so many years, I was surprised by all these doctors saying I was young and strong. Again, I defer to competent authority.  

Another member of the surgical team came by to say that I would be X-rayed and blood would be drawn in preparation for the surgery.  The nurses told me thatI was handling the recovery very well, and that someone would be by to take me to X-ray.  Shortly afterward an aide showed up to get me up and walking; I thought we were headed to the X-ray department, so I was surprised when we simply took a circular route out one door, two turns through the hall and back in the opposite door of the recovery room.  The nursing staff was pleased that the walk went well and said I would soon be released.  

Finally the anesthesiologist came by to explain the pre- and post-operative stuff, in particular that I would awaken with a breathing tube down my throat, and that there may be some hoarseness after it comes out.  I explained that I talk for a living, that I was a singer, and that I had a gag reflex capable of projecting that tube across the room.  I related that my friends referred to me as the “Power Chummer” for the violence, speed and volume of my vomit reflex, and that my dentist’s fingers were always in danger when working anywhere near my gag area.  He noted all this and said he’d take special precautions.  The breathing tube was actually the item that I was most concerned about.  It is odd how I fixate on such comparably minor things.  Perhaps it is a coping mechanism, because my apprehension about surgery was almost completely calmed by my performance in this catheterization procedure.

Soon afterward I was brought to radiology in a wheelchair by what seemed to be a NASCAR-trained orderly andX-rays were taken.  When I returned to the recovery room, my gurney had been stripped and I was visited once more by a member of the surgical team and released to the custody of my wife.  I explained the outcome and surgical recommendation to her surprise, and we wended our way home.

The Repair

The operation was scheduled forMonday, March the 20th, but I got a call from BIDMC on Thursday afternoon the 16th asking if I would like to come in “tomorrow,Friday”.  Since I was psychologically unprepared for this, I turned them down. I was planning one last weekend of particularly bad eating, anticipating severe post-operative dietary restrictions. It was, perhaps, a poor decision because doing it sooner would mean recovering sooner, but I am always resistant to changes in my plans, especially about such a major event.  I was soon to kick myself in the butt for my refusal.

Late on Friday I received a call from the surgical nurse at BIDMC saying that there was a possibility that I would be bumped from my priority position on Monday in favor of another patient who was in greater need.  It is nice to know that at least in some fields the neediest go first.  I was disappointed that my plans would change and angry with myself for turning down the earlier opportunity, but I soon relaxed and re-arranged my plans to accommodate the change.

I again went down to Boston the day before, but this time I took the opportunity to play nine holes at the TipO’Neil Fresh Pond Municipal Golf Course in Cambridge in accordance with my doc’s instructions to continue my normal exercise routine.  I would be unable to play golf for some time after the surgery, so it was nice play my last game on the course where my father learned to play, and named after our good neighbor and Congressman, Tip.It was a fairly windy and cold day, so I played in solitude, reveling in many fond memories of my boyhood in Cambridge. Later Fred and Kazue took me to dinner at a fine little Italian restaurant and I had a lovely relaxing evening and went to bed early.  Kazue was to fly out to her family home inJapan the next morning, so Fred would be driving me to the hospital quite a bit earlier than originally planned.

I arrived at the hospital at 5:30a.m. on Thursday, March the 23rd, before the nurses had even arrived.  Slowly the waiting room filled with other patients, all older and, to my eye, more sickly-looking than I.  They seemed surprised that I was alone, but as my wife and I discussed, there is little that a companion can do but sit around and eat horrible hospital food while waiting and worrying.  We both felt that she could both wait and worry better at home in the company of our Jack Russell triumvirate, Jac, thePrince of Poo, Oona, the Princess of Pillows, and Molly the Monster, Duchess ofDestruction.  The only strange thing was not having many of my usual accoutrements; my keys, wallet, pens, tooth picks, flashlights, whistles, firearm, speed loaders, reading material for a month on a desert island, water, Coke Zero, a week’s worth of HIV meds, etc.  I was equipped lean and mean with only my cell phone and a Pendaflex® folder with a copy of my passport forID, my medication list, glasses, pre-operative instruction book, Golf Digest and America’s 1st Freedom magazine.

At 6 a.m. the nurse called my name and I went for surgical prep.  They collected my valuables and clothes, verified my identity and reason for being there, had me lie down, started the shaving and prep washes, set the intravenous lines, as a parade of team members dropped by with their specific questions and verifications.  I listened to the arrival of the rest of my waiting room companions, bantered with the nurses and aides, slowly succumbed to the effects of fabulous medications and soon was wheeled out to surgery. I fell asleep before reaching the surgery, asI am prone to the call of Morpheus.

The Recovery

The CSRU

I awoke to the breathing tube and some person saying “Welcome back. Don’t try to talk, the tube is still in.”  I then fell back to slumber and awoke later with the tube out and two smiling Cardiac Surgery Recovery Unit (CSRU) nurses at my side telling me that things went very well.  I vaguely remember others doing the same, but the detail is very hazy, again the product of marvelous medications. I have a vague memory of some nausea from Morphine, but my next clear memory is awakening on Friday in the company of the smiling nurses.  They were very attentive, providing pain medication at the slightest prompt, getting me propped up abed in a near sitting position, and instructing me in the use of the Huggie Pillow and Incentive Spirometer, a wonderful little toy that helps you open and clear out your deepest bronchial passages.  Being a good patient and lover of technological doo-dads, I took to the toy like a dog to biscuits.  I made stellar progress to 750 ml of air and my nurses were thrilled with my progress saying that I would probably be out of the CSRU and down on the Cardiac Ward by afternoon. The Huggie pillow is used to reduce discomfort when coughing.  Just hug it tight and cough!  It is a simple but very effective aid, and will be my constant companion for a week or two. Soon after my surgeon dropped by, said the operation went very well and that he expected me to recover quickly as I had a “good pump and no heart damage”.  He also said I’d be seeing other doctors throughout the weekend as he was going away for a few days.  I took this as a very good sign of his confidence in my recovery.

The anesthesiologist stopped by to check on my condition and I thanked him for his careful work as I had very little hoarseness and a fine sleep and no breathing tube trauma. The nurses encouraged me on the way to the target 1000 ml on the spirometer and said I was doing well enough to be out of bed, into the comfy chair, and out of the CSRU by noon.  Since I did not respond well to morphine, I was being medicated with torvidal and dialudid, a most happy combo. There were some anxious conversations I overheard about needing a bed in the CSRU, and so, because I was feeling much better than I ever expected (let’s hear it for pharma), I worked extra hard with the spirometer while the nurses worked speedily to prepare me for transfer to the comfy chair and for discharge from the unit.  I was out the door around 1130 and on the cardiac ward by noon.  I was also ensconced in the best comfy chair on the ward, one of the “really nice new ones”, as I was told by my nurse.

The Cardiac Ward

My initial ward experience was also my first negative experience of the whole ordeal.  I use quotes only as a narrative aid; this is not a verbatim but only the gist of my conversation.  

When I asked for pain medication a nurse arrived with two pills.  I asked what they were.  She said, “Percocet”.  I said, “Those don’t work.  The codeine family always upsets my stomach.  I consider acetaminophen a fraud, as it does absolutely nothing for me. I had a bad response to morphine upstairs.  Could you please check and see if something else can be provided?”

“We don’t like you to stay on the drugs they give you in the CSRU.”

“Well, I’ll take these, but I promise you I won’t like them, and in the meantime, I would like you to check with my doctor.  After all, I am only atDay One of recovery.  Couldn’t we pretendI was still upstairs?  Most patients would still be there so shortly after surgery”

She returned to tell me that I was receiving torvidal and dilaudid upstairs, and I responded by telling her that I was feeling nauseous from the Percocet and then promptly vomited.  She rushed off to get anti-nausea medication and torvidal.  Case closed.

In the words of Monty Python,“Sometimes you have to complain until you’re blue in the mouth.”  You are your own best advocate.

Lunch arrived soon after, although I didn’t order it.  It was a nice chicken noodle soup, apple juice, tea and jello, all things I really love.  I was surprised that the soup was salted (yum!), and that they would give me apple juice.  Apple juice is something that for me certainly would counteract the stool softener provided to counteract the constipatory effects of narcotics and bed rest.  Since I was told to avoid caffeine by the cardiologist, the tea was also a surprise, but I refrained from drinking it until I could talk with the doc.  He later told me that a single cup was fine, that I didn’t need to worry about salt because my blood pressure was fine, and that I could eat everything in moderation (much like my pre-diabetic regimen).  Unfortunately, on the cardiac ward everyone is one the same low salt, low sugar, low fat diet, so I could not order anything contrary to that.

The next day my breakfast scrambled eggs and lunch chicken noodle soup turned out to be low-sodium atrocities, so I ate little of them.  Fortunately, theJell-o and low-fat Ice Cream (sugar free) were very good, as was the orange juice I chose as a beverage.  I spoke with the doc and he told me he would tell the nurses that I could have a packet of salt to liven up the bland items.  God bless him and the aide that obtained and gave me the contraband packet!

I was in a semi-private room because all the private rooms were taken by contagious cases.  I was paired with a pleasant but very ill Chinese man who seemed to be on Chinese time, awake late at night and sleeping much of the day.  He had a tendency to kink his tubes and set off alarms at two hour intervals or less, almost on schedule with my dialudid doses.  It is my experience that is difficult to get good rest in a hospital, strangely enough, even with a private room, so I heartily agree with the “get ‘em up, get ‘em out” philosophy prevalent today.

I was walking the hall with the assistance of a wheelchair and the physical therapist the late afternoon of Day One.  My first visitor, Bo, arrived shortly after my transfer and just before my wife did. Both were extremely surprised to see me sitting up and “looking so good”.  They both commented that my color was better, and I told them that my breathing felt like it was better than before.  It was then I realized that what I thought of as breathing problems, and attributed to my 30 years of cigarette smoking, were actually caused by my Coronary Artery Disease rather than a decrease in lung function. After all, it has been over twelve years since my last cigarette, and those Lung Association commercials of days gone by promised near complete restoration within a few years of cessation.  Of course, the Heart Association never promised that!  My wife later accompanied me on an evening walk down the corridor before she left for home.  She had brought me my favorite silk traveling robe, a well worn thing but much more stylish than the breezy jonnies the hospital provides, as well as my slippers and clothes for returning home.  It’s amazing how such little things can bring such great comfort.

My brothers Michael, Paul and David soon arrived to visit and also commented favorably on my condition.  It was a love fest for modern surgery.  Many faraway folks called that day and in subsequent days, and were equally amazed at “how good I sounded”.  Day One and Two run together in my dilaudid-addled memory, but there were no other negative moments.  The nurses and aides were fabulous (although I could have done without the 4 a.m. weighing).  All were compassionate, helpful and pleasant, even when I was not.

My only real discomfort was from the various drainage tubes that went to what my wife called the Kool-Aid box, and the IV lines, as they had a tendency to seek the least favorable position with the most danger of entanglement and were always in the way of whatever you wanted to do.  The least troublesome was the bladder catheter, of which I was barely aware.  It came out on Saturday, and a mighty strange sensation it was. I hope the rest would all be out by Saturday, Day Two, but the doc thought it would be better to wait until Day Three, Sunday, as I was putting out a tremendous amount of fluid.

I never looked at any of the scars, tubes, wires, etc. as I am a bit squeamish about such things, and thought it better that I ignore them as much as possible.  As it was, I did not even look at my scars until after I removed the dressings at home with my eyes closed and my wife guiding me. I continued to walk the corridors as I saw fit.

Sunday the tubes came out!  There were also five pacemaker leads to be removed that I had forgotten about.  Three of them came out easily, but I felt the fourth and fifth, so the ward nurse called a CSRU nurse to remove those, and proceeded on to the tubes.  They came out easily, but again with a sensation like none other.  Michelle, the CSRU nurse arrived to remove the troublesome leads, saying “These?  They always tug a little. We just pull ‘em.” and proceeded to do so. I felt only a slight tug as they released, but it still was a bit disconcerting to feel that internal tugging.  When nanomachines become the norm in the not too distant future, I’m sure that sensations like these will be common but just as strange.

The RC pastoral aide stopped by with Communion for me. We had a short service and I sang the Our Father that I learned years ago in the Choir School.  I still dearly love all those lovely melodic lines that Dr. Theodore Marier composed and taught me so long ago, and I miss him very much.  He was always very kind to me and a great encouragement.  Of course, he’d be appalled that the Viennese waltz Te Deum is one of my favorites, too, but I can’t resist that ¾ melody that trips so easily from my mouth.  “He who sings prays twice” (St. Augustine).

In the afternoon the physical therapist (or terrorist as my father used to say) arrived to review my post-release activity and rehabilitation plan and to take me for my first walk up and down stairs, a pre-requisite to discharge.  The activity plan is centered on ever increasing walking and general household activity for the first eight weeks.  Like the doctors, she endorsed my golf-centered rehabilitation strategy and told me to follow the guidelines in the booklet she provided.  That showed putting for the first 6 weeks, then 2 weeks of putting and chipping, and a move to the full swing at 8 weeks, probably at the driving range .  This will be followed by some real rounds of as many holes as I accomplish without taxing myself, progressing finally to full putting chipping and driving practice and 18 hole rounds.  People laugh about this, but it is a much more effective plan for me than going to a sterile rehab gym with treadmills, weights and bicycles.  It also serves my psyche well, and, to my mind, it is a way that is much better than stress relief and depression counseling and/or drugs (I already take more pills than most folks).  Daily singing and playing the piano should take care of the breathing exercises and provide aerobic benefits. These exercises, my trusty blood sugar meter and pre-diabetic meal guidelines should keep the weight and diabetes under control, too.  As the doctor says, I am more likely to do exercises that I enjoy than ones I abhor.

The doctor arrived later to inspect the wounds and tell me that I would probably be discharged on Monday, pending X-ray and blood test results.  Since my regular quarterly HIV appointment was scheduled for Monday, I called my PCP and asked him if the usual blood work could be done here and save me the trip over to the clinic.  He agreed and sent over the order for Monday morning.  I could also now use the toilet like a normal human being, and the washstand, too.  I was now champing at the bit to get home!

Release

Monday arrived, and the NASCAR-trained aide arrived to whisk me to X-ray and back.  The phlebotomist arrived with the umpteen tubes for blood work, and I slowly began gathering the few things I came with and that my wife brought to me.  Soon my wife arrived and I awaited the final discharge papers.  They arrived around noon, and I was off to home

The Rehabilitation

 The Ride Home

Oo! Ee! Oo! Ah-Ah! Ting tang! Walla-walla-bing-bang!  Every bump an exercise in tension and pain even with the final dilaudid dose coursing through my veins.  Every acceleration and braking a new adventure.  I am unable to ride in the front seat because of the danger an airbag presents to me, or any blow to the chest for that matter.  Even so, the ride home goes quickly and we stop by the drugstore to drop off the new prescriptions.  Since it will take a little while for the pharmacist to fill the scrip’, I ask Ann Marie to drive by my golf club to see if the putting green is open.  We do.  It is.  I talk briefly with Tony, the Event Coordinator, who is in charge of the pro shop, club house and golf operations in these pre-season weeks, tell him about my surgery and rehab plans, and that I will see him later in the week if I am feeling up to a short putting session.  We return to the pharmacy, pick up my order and finally arrive at home.  The dogs are thrilled I am home, but also seem to know not to jump up on me, sniffing me and my hospital smell.  I am quite tired and so, with my Huggie Pillow and Spirometer in hand, I slowly make my way down to the den, my favorite recliner and my universal remote control.  What a day!

📆 Week One

My first shower, remove the dressings. painkillers, regular food, my newly discovered love of flavored sparkling water, brief walks up the driveway, 10 spirometer exercises an hour followed by huggie coughs. I am at my “fighting weight” of 165 lbs. which I haven’t seen since my rock and roll days, and is 7 lbs lighter than at admission.  Ann Marie is staying home to help me during my initial weeks and make sure I don’t get into any trouble with normal activities. By Wednesday I am feeling fit enough to go to the putting green in the afternoon for 10 putts, ten minutes of rest,  10 putts, ten minutes rest , 10 putts, ten minutes rest while Ann Marie walks the dogs.  I am walking further up the driveway by week’s end, including a short slope which makes me very aware of my limitations.  I get in another putting session on Saturday, again while Ann walks the dogs.  I am off painkillers on Friday and starting to sleep more comfortably, no longer awaking every four hours.

📆 Week Two

Getting a little farther and longer for walks, I finally make it down to the barn and back, some more putting sessions, I begin to sing and play (gently) on my keys one or two songs.  Strangely enough I compose a new song.  The tune was running around my head when I awoke one morning and I jotted down some draft lyrics. Later those notes inspire me to compose an entire draft with verses, bridges and chorus.  I think that my new found breathing ease has inspired me, both literally and figuratively.  Cold, Snow and Rain put a damper on further outdoor activity.  I ask my wife to get the treadmill open.  I start this narrative. Tomorrow I get the upper plate that was superseded by my surgery, and I’ll finally be able to chew with my molars again!  It’ll be 40 minutes in the dental chair, and I hope not too strenuous a day

I realized yesterday that I had broken my caffeine addiction.  It reminds me of a day back in 1996 after I was first diagnosed with HIV when I looked down at my hands and realized I had stopped biting my fingernails.  It was completely unconscious, much like this caffeine change.  There must be something about facing mortality or being preoccupied with major issues that makes such things happen.

I went back and corrected some typos in this chronicle and started thinking about how Orwellian it is to be able to change stuff in cyberspace. History can now be changed on the fly.  Kinda creepy, eh?

Today’s trip to the dentist went well.  The bridge (splint) and plate fit wonderfully and I look a little less like Skeletor than before. I can now smile without scaring the children, and stop worrying about breaking the temporary splint. Of course I now must learn how to talk again.  I feel like Demosthenes at the beach with his mouth full of pebbles.  It will probably improve my Walter Brennan imitation, by crackie, and add to my repertoire of funny voices, but saying “Sally sells sea shells by the seashore” is now an adventure of enunciation.  It does take my mind off my wounds a bit and I hope to be able to eat a sandwich again soon (maybe even today).

The wounds are starting to become more sensitive as the nerves heal, a good sign, if an annoying one.  I walked to the bottom of the yard last evening and needed three stops to get to the back of the house.  There I entered the walk-out basement rather than continue up the next slope to the front door. I guess walking up the hill to the 3rd hole at the Shattuck is still far in the future for me.  Although I should know better, it is disconcerting to feel so good while sitting around and so bad when exerting myself.  On top of that, because I look pretty healthy, folks are surprised when I say “Whoa!  I’ve got to rest a bit.”  It’s very easy to forget about my limitations until I test them doing something stupid like reaching to the top shelf of the closet for my fedora.  Ahtch, that smarts!

I’ve been receiving regular visits from Nurse Tami of the Home Healthcare, Hospice and Community Services (HCS) agency.  I first encountered the agency when our old Scoutmaster and Camp Ranger, Bob “Hobar” Hutchinson was receiving their services during his last years, and was impressed by their dedication and willingness to go the extra mile for their clients, so I’ve had them on my charity list since that time.  When they told me prior to my discharge that HCS would be providing the Visiting Nurse services, I knew I would be in good hands.  She checks my functions, monitors my progress, answers my annoying questions like “should this look like this?”, or “should I be feeling…?”, and generally makes me feel special.  Doctors are great for the diagnosis, prognosis, prescription and skilled repair and they are heroic in their work, but nurses soothe the soul and make the world a more comfortable place, much like moms.  God bless ‘em all.

Today my chest incision feels like the back of Joan River’s head, all tight and bunched up.  There’s a little zigzag at the top of the scar that feels like a bow tied by Zorro and I’m beginning to feel the wrapper on that soda straw they relocated. All the incisions are now annoyingly aggravated by the touch of clothing, no matter how soft. I am feeling the return of feeling. I envision the nerves growing and the adhesions congregating in a crazy quilt of cells. And there are lots of quiet things going on inside, sensations from nerves I barely knew I had, those same nerves that provided the odd sensations when the tubes and wires were withdrawn.  It’s a wonderful thing, the body, but much better indeed when assisted by great doctors, medical teams and pharmacology.  I echo the immortal words of my father; “If I get sick, get me to Boston.” because as someone once told me, “You can’t swing a cat there without hitting a specialist.”

My good friend and neighbor Craig took me to and from the putting green today. We played a couple of sessions of “Safety Drawback”, equivalent to about one mile of walking, then walked to the clubhouse for a short break before playing a couple more holes, where he took me for 25 cent.  It was nice to have a companion for the session, and he will try to make it a regular Friday event during my recuperation, as he is working the 2nd shift and needs the practice as much as I, and I am motivated to get that quarter back.

Jac, Oona and Molly now think I’ve recuperated enough and are demanding my attention, pawing at my leg and treating me like the footman.  Jac, pretending he has never been fed in his entire life, lays forlornly, head on paws near the cookie jar.  Molly has returned to her usual routine, “Look at me!  I’m a puppy! Aren’t I cute?  Give me a cookie!” with her tail whirring like an egg whisk while the aloof Princess Oona sits regally atop her pillows awaiting her treats.  After their cookie break they demand access to the yard and chase the new grey squirrel from pillar to post to tree to porch and back again, When it begins to rain, Jac and Molly return, but Oona remains on guard, sitting as still as a statue, waiting for the squirrel’s next move and getting thoroughly soaked.  She is out for so long that I nearly forget she is out there, only remembering when Jac and Molly decide they need to go out again, and come demanding the doorman.  I call her as I let the others out, but she will not come and will not move from her spot, fearing Jac and Molly will reap the rewards of her vigil.  Not too long later Jac is knocking at the front door in his fashion, using the jumping body-slam method.  Molly comes when I beep her e-collar, but Oona remains until I resort to the whistle and gruff voice and she relents.  Ever the princess, she first reviews the scents, meanders a bit and then trots back to the house as if on parade, wet as a dishrag but with head held high.  She ignores me and goes directly to her pillow near the towel, as if to say, “I’m ready to be toweled off, if you please. And hurry, I’m cold.”

I must be getting better.  I’m getting chatty again.  

Today the steri-strips on my side-of-the-knee incision finally fell off. I was beginning to think they were attached with construction adhesive.  Now I must wait for the adhesive residue to gather enough lint to be peeled off.  It is much like the EKG lead and IV tape marks that took a week or so before I could scrub them off with a washcloth.  Normally I’d have used a solvent to assist me, but there were strict orders not to use any lotions or powders for a few weeks while the incisions healed. Now, WD-40® and Break-Free® are not exactly lotions, but I thought it prudent to treat it them as such. My next choice would be Skin-So-Soft®, the universal solvent, but that is definitely a lotion.  So, here is a market waiting to be exploited: a sterile solvent for adhesive residue on the skin.  The visiting nurse told me that folks are always asking her how the heck to get those marks off.  Before I went home, one of the nurses in the hospital suggested alcohol wipes, but I went through about ten before I gave up on that idea.  Maybe alcohol works well right after they are peeled off, but it was mighty inadequate when I tried it.  It could be an “elbow grease” problem.  My mom was always able to clean things that no one else could by using elbow grease.  I have no idea where she got the stuff, but I could never emulate her example no matter how hard or long I scrubbed.  Personally, I think she had mystical cleaning powers, much like the mystical powers that dogs use on you to get you to give them biscuits.  Very effective are those mystical powers.  I think parapsychologists might get better results studying those rather than trying to prove that ESP exists.

Today, Saturday, the end of Week Two, I will climb the mountain of bills on the kitchen table and begin excavation.

The excavation goes well and a stack of mail sits waiting to be brought to the mailbox.  Uncle Sam sent the tax refund.  

My friend Matt the Carpenter arrives around 4 p.m. to bring me to the Jaffrey Troop 33 Spaghetti Supper at the American Legion where I have a portion fit for a growing boy.  Someone in the kitchen knows their stuff because the pasta is al dente, and the sauce and meatballs are tasty and without aceta.  Dressed salad, travelin’ tomatoes, and garlic-spread laden, toasted bread fill out the plate, and remind me of many camping trips of my youth where the Saturday night menu matched this.  But …we never had yellow cake with chocolate frosting!  My favorite, the choice for most of my childhood birthdays, and a piece like Mom would cut, placing indulgence above thrift and abandoning moderation in a celebration of cake.  Yum!

I’m still learning to talk with all these extra teeth in my mouth.  It sure is easy to lapse into lisp.  Chewing requires careful attention and swallowing is strange, as my mouth expects to be empty after a swallow and is confused by the presence of the plate.  I have a semi-conscious trepidation, almost paranoia about swallowing the plate, and there is a bit of soreness on the upper left lingual gum line.  But they look great!

This has been a great week with real rewards from work, friends, colleagues, family and God and a week of great recuperative progress.  I can inspire 2500ml of air regularly now and fits of coughing no longer follow.  I am using the huggie pillow for a shoulder belt cushion when I ride, but I no longer need it to cough.  It still hurts a bit when I cough deeply, and there is pain and stiffness at the base of my chest when I deep breathe that passes with a few breaths.  Numbness and irritation describe the rest of my chest, while the places where the wires and tubes entered and egressed itch most annoyingly and cannot be scratched for fear of dislodging scabs. I logged about 2.6 miles on the pedometer today, and hope to see continued progress over the next week

📆 Week Three 

Steps Forward, Falls Back or Regression to the Mean

Because of my previously mentioned squeamishness about these things, I have been only checking my incisions for the danger signs and the fall of the steri-strips and have not paid much attention to their aesthetics, preferring to ignore their presence as much as possible.  Today, however, I got caught up in admiring them and the skill of my surgeon.  Not only do I have great physiological results from the operation, but it looks like the scars from the kind cuts will be fine lines rather than broad swaths.  Let’s hear it for Dr. Khabbaz and his team.  Hoorah!  I’ll look good at the beach.  Of course I haven’t been to the beach for nearly10 years, preferring instead to cultivate a fine farmer’s tan, but at least it’s still an option and probably a less embarrassing one because of the conversational value of the scars and the fact that they go better with fish-belly white than any other accessory.

I got down to my backyard shooting range yesterday.  The weekly .22 shoots at my gun club start in May, and, as firearms committee chairman, I am in charge.  I’ve already lined up folks to assist with transportation and the bearing of firearms and ammunition in line with my lifting restrictions, but it suddenly occurred to me that my own rifle is too heavy for me to use.  Well, there was only one cure for that, i.e., buy a new firearm.  Actually almost any excuse will do for a firearms enthusiast to buy a new firearm, but this excuse is better than most.  So Matt the Carpenter, another enthusiast and a hunter, was kind enough to bring me over to the local dealer where I purchased a Beretta Neos .22 pistol that I’ve had my eye on for some years.  Like many Italian products, its fine styling makes it look like its going 1000 mph while standing still, so I’ve named it the Italian Racing Gun or IRG (there is some history involved with the name that my oldest friends will recognize).  I’ll be at a distinct disadvantage competing with a pistol against rifles, but I’ve never really competed for the prize; I only compete to keep my skills sharp and for the fun and camaraderie with the other shooters, a great bunch of men and women.  So, that was the reason for my trip down to the range yesterday, to practice a little with the new pistol and do a rough sight-in at 100 feet.  I shot reasonably well and was pleased with the performance of the pistol. Although it is among the loudest .22 pistols I’ve ever used, it sits in the hand well, returns quickly to a stable sight picture after a round is fired, and can be stabilized easily with the left hand without any danger of impinging the blowback path.  I’m looking forward to sighting it in for 50 yards and seeing how well I score.  Tonight is the monthly club meeting, so I’ll get to see everyone, firm up the logistics for the shoots and offload the work so I can continue to concentrate on recuperation, but still have some fun.

The walk up the hill from the range still requires two stops for rest, an improvement over the three stops I needed last week. I am supposed to be taking longer and faster walks this week, so I felt that a more strenuous walk would be advantageous, too, as long as I didn’t overexert.

I was able to catch a ride to the golf course this afternoon where I putted 140 balls to the hole. So I estimate I putted 250 times or more with commensurate walks back and forth to finish putts, 20 or so squats to retrieve the balls, eight 75 yard walks to the clubhouse to sit and rest and then return to the green.  Ann Marie picked me up on her way to the Jaffrey C.O. and dropped me off at the Pizza Barn for my first Roast Beef sub in months.  Gee, its great to have molars again.  Ann finished her working day at the Central Office (I should remember many of you, dear readers, don’t have the slightest idea what a Telephone C.O. is.  Too many years in any biz makes us forget that we use trade lingo so facilely and blithely.), and she picked me up to return home and then right out again to take me to the Rod & Gun club meeting.  Everyone at the club was most solicitous about my condition, and Jim Q, the reigning Club Champeen .22 shooter, kindly gave me a ride home.  It was a tiring day.  Although I logged only 1.5 miles on the pedometer, they were strenuous ones.

When I arrived at home, I ate the other half of my sub and watched Jack Bauer whisper and shout his way through another episode of 24.  I don’t remember who first pointed it out to me, that Kiefer Sutherland only talks in those two modes on that show, but it is hilariously true.  I fell asleep in the Captain Kirk chair in front of the widescreen after the show, but I awoke and made my way to bed after taking my midnight pills at 1110 p.m. according to my log.  I was so tired that I really don’t remember any detail.

This morning Ann dropped me at the putting green on her way to work.  Hundreds of balls later, punctuated by sit-downs in my folding chair by the green, she picked me up around lunchtime on her way again to the Jaffrey office.  We had a lovely lunch together at Aylmer’s Grille, a fabulous little restaurant in Jaffrey.  It is a family-owned place and Aylmer the chef is a hometown boy whose cooking is truly wonderful, and the luncheon was superb.  Ann Marie and I have not been out to eat together in quite a while, so it was a very nice to share a meal with her, especially since it was her first meal at Aylmer’s.  Afterward I got a haircut at Stan the Barber’s and Ann dropped me at home.

I tried to complete my deceased mother’s taxes, but was soon stymied by the lack of W-2s from various and sundry folks, so an extension is in the works.  I also received a call from Kenny the lawyer, whom I have engaged to handle Mom’s Massachusetts probate as I cannot handle the task in my present condition.  After that I was ready for a nap and slept away the afternoon on the couch, awaking to the ministrations of the extremely excited to see me Jac.  The pedometer tells me I logged 1.8 miles so far today, and notwithstanding the nap, still feel a bit tired.  After a brief phone conversation with my sister Tricia in California about the probate, I went upstairs to greet my wife, processed the new mail to stave off development of another mountain on the kitchen table, and then repaired to the office to continue the chronicle.  I’ll be tired again tonight.

Tomorrow my good friend Jack T. will be visiting, so I expect a very relaxing day listening to music and watching the home theater.  Jack is bringing some 16 2/3 rpm recordings from the distant past because I can play them on my new turntable. It has a speed control that allows halving the 33 1/3 LP speed, and that should be adequate to the job.  Jack is an audiophile / stereophile and an old and close friend.  I am a budget audio/video enthusiast who tries to squeeze the most out of every dollar.  I’ve been on the bleeding edge of audio/video for years and have built a formidable 7.1 home theater in the den that Jack is anxious to hear, as all the speakers are matched and full size, albeit a bit old and truly the weakest part of the reproduction chain I have aggregated (someday this will change, perhaps next year if the market favors my investments).  We’ll be cranking up the volume and shaking the dust from the rafters as we work our way through LP, SQ, CD, DVD, SACD, DAD, MP3, MPEG-4, LD (both CAV & CLV), HD and NTSC, a veritable alphabet soup of audio and video formats.  About the only thing we won’t do is the tape formats, cassette, reel to reel and VHS, unless there is something that he really wants to hear from my own compositions of the past.  I’ve been meaning to start restoring the tapes I produced in the 70’s and 80’s, but that requires repairing a few tape recorders, and, strangely enough, baking the tapes before playing.  Apparently there was a problem, unknown at the time, with the binder used to hold the iron oxide on the Mylar recording tape of that era, and baking is the preferred and maybe only way to restore them for archival recording onto another medium.  Something about the difference between long and short chain molecules is the culprit.  So, that project is on hold until I get a Round Tuit, a scarce commodity these days, and enough spare cash to effect the tape recorder repairs.

Finally my knee incision is more bothersome than the chest incision.  I can understand why folks complained about the long zipper incision of days past, as the flexing knee makes this one a bit sensitive and the touch of clothing stings it.  Internally, the regrowth of nerves along my shinbone (I think) makes that sensitive too, so I can imagine how much worse the long zipper incision was.  I feel achy all over, as though I had the flu, although when I pinpoint the achiness, it is centered on my chest, but it generalizes to my body.  Putting is also hard on the lower back, at least for me, so that is part of the achiness too.  I do feel like I could do a little chipping, but I will wait for clearance from the doctor.  I will see both the cardiologist and the BIDMC nurses on Thursday. When he returns home after Wednesday’s visit, Jack is giving me a ride to Freddie’s so that Ann Marie can avoid one of the two 4 hour round trips to Boston that would otherwise be required, and I can sleep late.  I am forever grateful for the blessings of friends and family.

I worked out on the treadmill today, and made the mistake of setting it for the “moderate” pre-programmed fitness walk.  Perhaps it is moderate for someone who runs or walks very briskly, but at its peak it was a bit too fast for my condition.  It certainly got my heart going, and I did notice that my resting heartbeat recovery time is lesser than before the surgery.  I think I’ll start keeping a record so I can better ascertain my progress in that department.  Anyway, I had to stop the machine after about seven tenths of a mile, and will go for a less vigorous program for my next session.

Jack arrived early this morning and we went directly to copying the 16 2/3 rpm record to DVD after first connecting the Left and Right channels of the Stanton turntable’s phonograph cartridge pre-amp in parallel to produce a true mono signal.  After auditioning it in Analog Bypass mode, we switched in the NEOS M decoder which produced a great three channel mono soundstage and engaged the subwoofer.  It is astounding that a record that was used in an automobile record player was still playable and retained its high fidelity mono quality, albeit through a fairly noisy surface.  The DVD copy turned out well.  I will continue to use his paralleled L/R trick when playing mono records because it is truly a sonically superior solution.  I will try to rig it up as a switched option at another time.

Jack and I had a great lunch at Aylmer’s Grille in downtown Jaffrey, a little gem of a restaurant advertising “Creative American Cuisine”.  They held the last seating for us at 2 p.m., and we ate a leisurely meal before we headed for Cambridge where he dropped me off at Fred and Kazue’s.  Kazue has returned from Japan, so I was treated to a fine bowl of delicious lo mein for supper.  After a lazy morning the next day,  I accompanied them to BJ’s and then they brought me over to the Longwood Medical Area in Boston and dropped me off around 1:15 at the BIDMC Shapiro Campus for my Cardiologist appointment at 2.  Because I was early, the cardiologist was able to see me early.  I met him in the corridor as I was being escorted to the examining room, and he looked at me with a look of puzzled recognition, and said he’d be along shortly as he wanted to review my records.  When he came in, he told me that I looked more like a man who had been in cardiac rehab for 6 weeks rather than 3, and looked better than when I first saw him, pre-operation.  After the examination he told me that things sounded great, that I should continue to use my judgment about when and what to do as it seems to be working out well, that he wanted to see me again in 5 to 6 months, and to schedule a stress test and blood work beforehand.  He also told me that my original false negative on the thalium stress test was the result of a balanced ischemia, that makes it look like every part of the heart is receiving blood flow, but the supply is inadequate for all areas when under stress or at high demand.  I mentioned that my next appointment was with the nurses of Farr2 for wound inspection, and he joked that, appropriately enough, the Farr building was far away and that I probably didn’t need a stress test if I could make it there without a rest.  He also put me back on Toprol XL, although at a reduced dose, and discontinued Lopressor.  I tolerate Toprol better, with fewer peaks and valleys, and my blood pressure was too low, around the 90/60 mark, using the current dose.  It is now in the 119/68 range.

I set out for the Farr building and again I was early, this time by hours, but Nurse Chao was able to see me.  While I was waiting for here, I met a family in the solarium.  They were there for their father who was to have bypass surgery the next day or on Monday.  I told them that I was 16 days in recovery, to their amazement, and mentioned that the anxiety prior to the operation was worse than the operation itself.  They said their Dad was worried with anticipation too, so I offered to speak with him as someone who has experienced what he is about to go through, and might be able to reassure his mind about the skill of his surgeon, Dr. Khabbaz, and the care team.

Nurse Chao was very impressed with my healing.  All the wounds look good, and my recovery is one that pleases all who cared for me; astonished looks were the order of the day.  I was able to take the bus and subway back to Fred’s in North Cambridge, a trip that brought back memories of commutes of my childhood and early career.  My wife arrived around 6 at Fred’s and we stopped briefly at Bo and Diane’s so that Ann Marie could see their Somerville home and the wonderful job they did remodeling it.  It was a busy and tiring day, the ride home was uneventful and quick, and I slept well that night.

Yesterday, Friday, my friend Craig again picked me up for putting practice, and I managed to beat him at safety drawback for $1.  So I’m up $0.75 in the running total.  We had lunch at Aylmer’s (I’m filling up my frequent diner card), and then he dropped me at home where I played George Jetson and set all the Roomba robots to vacuuming while I learned how to operate the new Scooba mopping robot.  The rest of the day was spent trying out the Scooba on the various tiled floors throughout the house, with a brief respite while Nurse Tami was here for followup.  I do like the new robot, and it cleans better than I do.

Later George Streicher, the Fish and Game chairman of the gun club, stopped by to update the Annual Children’s Fishing Derby letter and print out 50 copies.  I later revised the letter and will be contacting George today to replace the copies he took last night.  I hope to take today a little easier than the past couple, and get out for a nice walk around the property.  I continue to gain strength and stamina, although I still have severe limits.

📆 Week Four

Less Chat, More Healing

Week Four begins: I am monitoring my blood pressure daily now that my cardiologist has reduced my Toprol XL dose.  I definitely tolerate it better than Lopressor.  I’m not experiencing any of the dizziness I had while on Lopressor.  The knee incision is the most bothersome, although the chest is also now sensitive to clothing.  I see the dentist tomorrow for an adjustment to the new plate.  I’m getting used to the routines associated with it, although I did forget that I need something portable for overnight cleaning and storage while I was in town last week.  Fortunately, I have contacts in the dental industry and was able to obtain a substitute (Thanks, K!)

I’m enjoying playing at George Jetson and directing all the robots about the house. Actually it’s probably more like Mickey Mouse in the Sorcerer’s Apprentice.  They certainly clean better than I do, although that is a faint praise.  Let’s see how soon I get tired of their care and feeding.

Reality is setting in.  In my recuperative state I have been ignoring most chores as they are beyond my limits.  This week I have been feeling well enough to start some of the light chores.  We are replacing a door in the basement studio that is leaking, so I must get cracking on clearing that area out.  Matt the Carpenter has already ordered the new door and it will be here within two weeks.   I’m sorting out the wires and equipment to be moved to the barn or remain in the studio. I made great progress, although there is much more to do.  I hope to get many things moved to the barn over the next week, especially the computer armoire, a great idea in concept, but flawed by my inability to use it as intended, i.e., open it to use the computed and close it when you are done.  Cleaning it out was a major chore, organizing, tossing and/or storing many small items.  The only problem now is the 10 lb weight lifting limit and the “no tractor driving” constraint.  I hope the doc releases me from those soon, but I also know I shouldn’t push it.  So, it will be many trips to the barn carrying small items or making piles of stuff that can be carried by others or by another driving the tractor.

I have decided that the studio will not be separated from the home theater room as originally intended, and that the door to the theater must be rethought.  I’ve also decided to complete the basement bathroom prior to finishing the theater, so all the stuff in those rooms must be moved to the barn or garage.  I did make some progress on the garage this week with the help of my brother-in law, Eddie.  Much stuff was thrown away, a task that I always find tough when applied to useful things like motors, and amplifiers and automotive parts. But I’ve now lived long enough to know I will never use those “I might be able to use that” things, so disposal is less heart-wrenching.  However, this does not apply to sentimental memorabilia, and probably won’t until I literally can’t remember what I was saving it for.  I cleaned off the other half of the old REKording mobile studio table/case, and we prepared it for use as the bottom of a scrap wood cart after much discussion about the configuration.  Right now there are various stacks of plywood and lumber leaning at various places in the barn.  Some is scrap, but much is full dimension.  By putting it all on a cart, I free the wall space and gain the convenience of easy relocation.  I separated some things out for the second-hand shop and some for consignment.  I also found the box containing my junk drawer from the Highland Ave. apartment.  I didn’t have the heart to sort it out, because I’m sure there will be at least one, “I’ve been wondering for years where that thing was” moment.  I should just throw it all out, as I’ve never needed anything in there since it was packed in 1988.  Or, at least, never knew that a needed item was in there. Perhaps a compromise cursory perusal will do.

I think what I have accomplished over the last two weeks would have taken about two or three days to complete under normal conditions.  Until my strength is at that level, I will not consider myself fully healed.  I am champing at the bit to start fully swinging a golf club and attempting to walk and play a few holes.  Again I hope the surgeon will release me from some restrictions.  My cardiologist told me to trust my judgment “as it seems to be working fine so far”, so I hope the surgeon is of the same mind.  I am anxious to rebuild my strength, and the treadmill, yard and driveway are very boring. The putting green is less so, but I need the more aerobic workout that the hills can provide.  Being able to walk and play a complete 18 holes will be a major milestone in recovery.  Being able to do it as I did prior to the surgery will mark near-full recovery.   Being able to keep up with the local dew sweepers for front 9 holes will mark full recovery.  They carry their bags and walk and play very fast.  Previously, I was unable to keep up with them because of my shortness of breath during exertion.  With the improvement in breath I have experienced after the surgery, I expect I will now be able to keep up with them on their 1½ hour, 9 hole pace.  I base this expectation upon my experience on more flat terrain such as the Rutgers Golf Course where I was able to make very good time in the past, albeit with some leg pain and shortness of breath. I see the surgeon on next Tuesday the 25th.

📆 Week Five

Reality Sets In

In some ways, it has been fun recovering.  I am writing more. Correspondence with my nephew in France and niece in Morocco, typing this little chronicle, and some songwriting has been keeping me amused, along with the telephone, DVDs, CDs, satellite and computers.  I’ve been out to eat more in the last month than I would in 3 or 4 months normally.  The inability to drive is the most maddening, and release from that restriction should make my life even more pleasant.  I am making progress with little chores I have procrastinated about.  But reality is impending.  The drainage ditches need to be re-dug and the back culvert needs resetting. The trench for the electric service needs to be dug, the conduit placed and covered with sand. The driveway needs to be raked.  The area around the barn needs to be prepared for the concrete apron.  Mom’s probate must be finished. And I must return to work.  All of this is now weighing on me as I recover.  Of course, this could also be the normal course of elation and depression that follows a major procedure like this.  I’ll mention it to the doctor.

Everyone has been most kind during my recovery.  My kitchen table is full of Get–Well cards, many with Jack Russell themes, and the kind thoughts, words and prayers are much appreciated.  I’ve received calls from customers and co-workers, friends and relatives, all most solicitous.  Almost everyone is surprised at my sprint to recovery, as am I.  Tomorrow the surgeon awaits and I hope to get good news and release from some restricitions.  It will be a tiring day, as I am taking the commuter train and trolley to my destinations.  I have a final appointment with a study I am participating in at 10 a.m. then the appointment with the surgeon at 1:30 p.m.  After that I intend to stop at Jack’s to play with some equipment and then go to dinner at Legal Sea Foods where I intend to have a broiled loin of Haddock (Yum-yum!) and then catch the commuter train back to Fitchburg where my wife will fetch me.