Arresting Developments Part II
by Marshall Snider
Open heart surgery sucks. I’m not criticizing cardiovascular surgeons and their teams. These people who perform more than 500,000 cardiac artery bypass surgeries in this country every year work miracles and save lives. Nor am I disparaging nurses, aides and other hospital staff who assist in recovery. These are wonderful, competent and compassionate people who deserve our gratitude.
It’s just that as a recipient, this was an extremely unpleasant albeit necessary experience. After a heart attack on July 3, tests revealed I had a serious blockage in a major cardiac artery, as well as blockages in other arteries, one of which had caused the heart attack. My condition could be addressed only by cardiac artery bypass graft surgery (what they call a CABG, pronounced "cabbage"). I could have chosen not to receive a CABG (or any other medical vegetable), but that wasn’t much of an option; even with medication, exercise and a perfect diet, my odds of a fatal heart attack absent surgery would increase 20–30% each year (I did the math; I’d never get to collect on Social Security, lock box or not). So I said sure; how bad could it be?
Here are just a few of the fun highlights I experienced during CABG surgery (blissfully sleeping through it all). They sawed my sternum in half; spread my ribs apart; stopped my heart and replaced its function with a little machine; stuck a tube down my throat to breath for me; repositioned a couple of chest arteries to redirect blood flow to below one blockage; and grabbed a couple of veins from my legs to create additional bypasses past blocked arteries. It seems just like plumbing, though most plumbers do not have to sew blood vessels the size of a piece of spaghetti together in six places, making sure there is not a hint of a leak (apparently, they can’t use Teflon tape in these operations).
Oddly, until I came out of the anesthesia none of this bothered me. But over the next 24 hours I realized that the fun part must be over. Despite heavy narcotics, I felt as if I had been beaten across the chest with a baseball bat. It would be okay if I could just lie still, but they insisted on my walking (if you can call it that) the day after the surgery. The two tubes draining fluids from my chest made the process even more difficult; nurses had to teach me how to get in and out of bed and had to provide hands-on assistance for a while.
In the movie North Dallas Forty, Nick Nolte plays an over-the-hill pro football wide receiver. In one scene, he tries to get out of bed the morning after a game. It takes him 10 painful minutes. This is how it was after surgery. My all-time slowness record for getting to a bathroom 15 feet distant and returning to a not-too-uncomfortable position in bed was a sizzling 25 minutes.
Most interesting was the pharmaceutical balancing act. For every drug administered for reducing pain, warding off infection or thinning blood, there was another drug to counteract the side effects of the first. Painkillers worked great but made me nauseous, so I got regular anti-nausea injections. Something else constipated me, and you don’t want to know the countermeasures for that problem.
Eventually, I could get in and out of bed myself, though slowly and painfully. I could walk down the hall and sit in a chair to read (well, try to read; I had all these books to pass the time but for the first few days, lulled by narcotics, I couldn’t focus on the print or stay awake long enough to read a page). I was sent home eight days after the operation.
As happy an event as that was, it was somewhat scary. After more than a week of 24-hour intensive monitoring and care, they just wheel you out the door with a page of typed instructions and a doctor’s appointment in three weeks. You’re on your own, dude; don’t bleed out or rip up your sternum and you’ll be fine.
At home, I noticed there was no motorized, 8-function hospital bed with lots of handholds to grip onto for getting up and down. I regressed to the lengthy ordeal of getting in and out of bed that I thought I had left behind at the hospital. This process eventually became easier, though it still required patience, balance and proper breathing.
The day I got home, I started walking. Over several weeks, I worked my way up to 40-minute jaunts. This was not bad, considering that my first day home I took a five-minute walk and barely got out of my back yard.
The two major challenges of returning home were the drug and activity balancing. Doctors want you to take narcotics so you will be pain-free and therefore more active, which speeds recovery. They instruct you to take a pill before you start to hurt. Anticipating when you are about to feel pain is quite a trick. On the other hand, they want to wean you off narcotics and onto non-narcotic pain relievers. And because recovery does not progress in a straight line (you don’t have good days and bad days, you have good hours and bad minutes, in no particular sequence), whatever medication program worked well yesterday is not guaranteed to work well today.
There is a similar juggling act with activity. You are encouraged to walk, do light housework, and keep moving around. But don’t push yourself or it could inhibit recovery. Where is the bright line between the right amount of activity and too much? I still haven’t found it.
Eventually, I started cardio-pulmonary rehab—a health club with nurses. The staff develops an exercise program, slowly increasing the amount of exertion, all the time monitoring heart functions. Cardiac rehab was enjoyable—a chance to get out and do something positive surrounded by other heart patients and dedicated professionals; part rehab and part support group. Although a buggy whip was prominently displayed in the corner of the room for those who needed an incentive to increase their exercise intensity, I never actually saw the staff use it (despite their threats).
I anticipated being 100% recovered in six to eight weeks. I now know that "100%" is a future concept, maybe nine months or a year away. As I write this, ten weeks post-op, I am at about 75% of my former self. Improvement occurs slowly and subtly.
My surgeon promises I’ll be in top shape by late winter. By then, I anticipate this will seem like some dimly distant unpleasant event. I will be glad I was able to repair my arteries, add many quality years to my life, and the fear and pain of the surgery will seem a small price to pay.
Editor’s Note: Former President Bill Clinton underwent cardiac artery bypass surgery 6 weeks after Marshall. For some reason Clinton’s surgery received more publicity.