My uncle, Vinay Mehta, who had his second bypass surgery four days earlier, is rushed back to the ICU hooked up to monitors and multiple IV lines.
A critical care doctor who wears cowboy boots and uses words sparingly is at the foot of the bed, and three nurses adjust drips, measure my uncle’s blood pressure and adjust his oxygen mask.
In medical jargon the critical-care doctor, who helped in the resuscitation, updates me. “He passed out in the bathroom. They did CPR chest compressions for three to four minutes. Not sure if we lost his pulse. He started waking up, on a little bit of Levophed, oxygen saturations is OK ”
I glance at my uncle. I am comforted that he is not on the ventilator, is moving his hands and feet, and is conscious and aware, but barely. What happened? What made him pass out?
Finding this out and fixing it may determine whether he survives.
One possibility is that he had vasovagal syncope. Simple abdominal pressure of urinating or having a bowel movement can trigger the body to overreact, causing a sudden drop in the heart rate and blood pressure, which compromises blood to the brain and causes the patient to faint. A natural response of the body is to get more blood to the brain, and you can do that by being horizontal.
Complications are a dreaded event after surgery.
After cardiac bypass surgery the most common complications include a heart attack, which occurs 5 to 10 percent of the time; arrhythmia, an abnormal atrial or ventricular heart rhythm, which occurs nearly 40 percent of the time; and stroke, which occurs 1 to 2 percent of the time. Cardiac surgery carries a risk of death among 3 to 4 percent of patients.
Once I watched a patient’s heart go into abnormal ventricular rhythm. The ICU nurses quickly shocked it back into regular rhythm, the patient revived and soon after, went home.
Another time, I watched as a patient developed a cardiac tamponade — bleeding into the sac around the heart. This complication squeezes the heart chambers, not allowing them to fill and pump blood forward. The surgeon took the patient to surgery, drained the sac and plugged the bleeding.
In the morning after a detailed review of the CT scans, the chest X-rays, and the drop in the blood count, it becomes clear that my uncle is having internal bleeding in the chest — a complication that occurs 5 percent of the time.
I stand next to my uncle’s bed and break the news. “They will need to reoperate,” I tell him.
“Open my chest again?” he says in a fatigued feeble voice.
“Yes,” I say, holding his hand.
I explained the findings of all the tests. He looks devastated. “Do what you have to do,” he says.
The surgeon’s nurse comes in after me and explains in detail. She tells him there is a “leak” and there is hope that the repeat surgery will find it and fix it.
Again, we are all in the ICU waiting room, waiting for the beige phone on the wall to ring. A call from the OR nurse informs us they have started. After 20 minutes, the surgeon calls and talks to the son. “They identified the leak and patched it up,” he reports.
There is tremendous relief and jubilation. In an illness or a complication, finding the underlying problem, however big or small, is often the most critical first step. That is where tests such as blood draws, X-rays and CT scans are incredibly helpful.
The first question my uncle asks when the respiratory therapist removes the tube from his throat is, “Did they fix the leak?”
His son reassures him with a big smile and a nervous laugh. “Yes, they fixed it,” he tells his father.
The second postoperative recovery is slow but smooth. I remind my uncle he must use the incentive spirometry, a smoking pipe-like tube, to keep the lungs open in order to avoid pneumonia. I insist he move both his feet as if he is pushing the gas pedal to avoid blood clots.
He spends the Labor Day weekend in the hospital, walking and conversing with the nurses and family, and enjoying his morning chai, with no more major events. The recovery is not over, I remind him. “The surgery maybe, but the psychological impact takes months to recover from.”
Two weeks to the day after he is admitted to the hospital my uncle is discharged, a stay longer and more complicated than he had expected. A few days later my wife and I visit him. He is sitting in the family room with his back to the large bay windows, facing his unattended garden. He stands up to greet us; I see he has his strength back.
We joke and we laugh, a conversation starkly different from what I had before the surgery. As I leave him, he escorts us to the door. At the moment, I feel proud to be a doctor and that my profession has helped my uncle in his time of need. We may not be perfect but with passion, compassion, caring and the best knowledge available, doctors, nurses, health professionals and the medical community provide good care for patients like my uncle.
This is the last in a series of columns about one man’s journey through heart surgery and recovery.
Source : Commercial Appeal