November 1, 2023
A cardial trifecta
Today
It’s a new month, on a morning that feels even more like the first day of the rest of my life than my mornings usually feel. Before heading out for coffee at 7 sharp I take my pulse, to see what effect there has been of stopping my calcium blockers four days ago. 51, with a rock-steady beat. I haven’t seen a resting pulse rate above fifty for over a decade, I’d imagine. For most of the past year it’s been frighteningly hovering around in the low thirties.
I feel fine this morning, clear-headed after the anesthesia wore off (some evidence: I solved Wordle in only two guesses this morning, before coffee!). And nothing hurts, although there’s still stiffness in my neck from the bandaging I need to keep in place for another day or so that covers up one of the multiple penetration points I was subjected to yesterday. And there’s still the bandaging over the primary access point, my groin, that needs to stay in place for several days yet. And I’ve got a slightly blistered upper lip, from the probe they ran down my esophagus to monitor my heart from the inside. But no pain really, even though they told me to take Tylenol as needed and sent me home with a bottle of some opiate as a backup. Really, the only painful sensation was when urinating - a stinging sensation reminding me that I was catheterized there too. I haven’t even needed the Tylenol.
I’m on light duty for a few days - no lifting over 10 pounds to not stress the groin, no biking or driving for a bit longer, but short walks are OK. So we’re in a perfect location- it’s a block to Lovejoy Bakers where I’m sitting now, and a block or two to two Italian restaurants. Not a bad place to chill out for a few days. And I won’t miss the biking for a bit, because the season’s first atmospheric river is due to wash over the region starting this afternoon.
So, about Lovejoy Bakers. I’m here because it’s only a block from ‘home’ and opens at seven. Years ago though, before we sold our condo, it was my main breakfast destination. I broke off of it after we moved, but also because it really dropped off in quality during and after Covid. I tried it a few times but then gave up on it. I came back a few days ago out of convenience, and it felt like the same comfortable and welcoming place I remember from years ago - a great selection of pastries, a few decent hot breakfast selections if that’s what I’m in mind for, good lighting, good background music. This morning I gradually realized that I was hearing the lovely sound of Rachael Price, the lead singer of Lake Street Drive.
At coffee with Elizabeth two days ago she filled me in. They’re under new management, and it’s back to the fine place it used to be. So I suspect I’ll be spending many mornings here this month because it’s a shorter walk than Cafe Umbria.
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Yesterday
I’m due to check in at Admitting at 6:30. It’s about a twenty minute drive with reasonable traffic, which we can expect at this time of day - east on I-84, south on I-205, freeways all the way. We allow plenty of time though, getting up before 5:30 and leaving 20 minutes later. We arrive three minutes late though, because somehow I miss the turnoff to 205 and have to drive a few miles east toward Troutdale until we come to an exit and I can backtrack. It’s not easy driving on the freeway in the dark when you’re still half awake, haven’t had coffee because you’re fasting, have hardly driven in the last two months, and are still getting over jet lag!
So what is there to say about this procedure, in case you’re just curious, or considering it for yourself, or want to compare against your own past experience? First off, I’m very fortunate because I’m being treated at Kaiser Sunnyside Medical Center, rated one of the top 50 hospitals in the country by Healthgrade. And I’m in excellent hands - and many of them by the time I’m done - starting with Mary Jo I think her name was, the smiling prep nurse who greets Rachael and me before sending her away to the cafeteria, assuring her they’ll keep her posted through texts at appropriate times. She takes my vital signs, shaves me on most of the front of my torso, my lower back and groin where the catheter will be placed, takes my signature on consent forms, jabs some IV probes into my wrists, gives me an overview of what to expect. And then the lead anesthesiologist comes in, Dr. Ann Stevens, a very personable, upbeat woman who goes through in great detail how anesthesia will go and why it’s being done as it is, and then a second cheerful and smiling woman, Scout - the second anesthesiologist-comes in and introduces herself. They outline part of the procedure - I’ll get a catheter through the groin that the ablation will be effected through; and they’ll ram in a second catheter nearby so I won’t pee on the operating table; and then they’ll shove a tube down my esophagus so they can monitor my heart from the inside, including scanning my left atrial appendage for any evidence of a blood clot that might dislodge and cause a stroke, which would be a show stopper in more than one way. There’s more, but those are the high points.
And then, here’s my electrocardiologist Doctor Lin sitting down in front of me to go over the procedure again. He’ll run a long, flexible catheter up a vein from my groin to my heart, and then preform three (!) ablations because I have three different arrhythmias going on - AFib and SVT that I’d known about, but also atrial flutter - something maybe I glossed over when told this before, not recognizing it as different again from AFib.
Jackpot! I’ve hit the Cardial Trifecta!
So three different spots to scar, in two chambers of the heart. He’ll start in the atrium with the source of Afib, then atrial flutter, and then perforate the wall between the chambers to access the upper ventrical to try to find the source of the SVT. To do this they’ll need to conjure an arrythmia so they can locate the source, using doctor magic - it’s why I’ve stopped taking my calcium blocker three days ago, so I’ll be more susceptible.
What could be simpler? Really of course, this is all such a miracle of modern science and medicine. In some ways it’s a curse to be living through this period of time, but in others it’s a great blessing if you’re fortunate and privileged enough.
So enough chit chat. Another guy comes in with a wheelchair and they wheel me down to the hall to the operating room. I think the anesthesia has already entered my veins by now, and I’m slowly starting to go under. The door opens, and I’m stunned by the scene - it’s astonishingly high tech with complex equipment everywhere and eight or ten people surrounding the operating table. Above it is an enormous screen filled with information, including a large, very detailed image of my heart, looking to me like a plucked chicken.
Doctor Lin tells me again that I’m here for ablation surgery to improve my heart, gives a fast run through of the procedure, and then points to the screen and says what they’re hoping for - it’s momentarily overlaid with a bright orange, grinning Jack-O-Lantern, but he says they hope they’ll do better than that. This prompts me to joke back, looking at the crowd standing around me, that I’m feeling like I’m really getting my money’s worth for my $15 copay. I’m very funny when I’m under anesthesia, a great wag.
And then I tell them all how grateful and appreciative I feel, because it’s true. And then, it’s lights out.
I come to about six hours later, with a different attendant nurse on duty. After I’d wakened up a bit he gives me the post-op instructions to read and then here’s Doctor Lin sitting down in front of me again. He’s telling me how it went - perfectly, is my take from what he was saying. There was one change to the plan - my SVT arrythmia started almost immediately, so they began with killing off that rather than taking it last. He sounded quite confident, said that all three conditions were treated successfully with no complications; and afterwards they made attempts to trigger another arrhythmia, but were unable to.
And then he’s gone, and I spend the next two to three hours coming out of anesthesia, eating a couple of bananas, hydrating, and trying to urinate because they won’t release me until I do. I’m completely empty - they said I urinated about a liter while on the operating table - and it takes seven glasses of water before there’s any stirring down there at all; and when it does finally come it’s slow and it stings, reminding me I’ve been catheterized there too.
Rachael’s been notified that I’m out, am well and in recovery. It’s been a long, stressful day for her waiting for word in the cafeteria. She didn’t receive any updates during the procedure, so she was really in the dark. And, she was frustrated because her iPad died and she’d forgotten to bring its charger with her. And when she turned to her phone, she realized she isn’t getting emails because it’s the new Samsung S23 she just got a few days ago and for some reason her email accounts didn’t transfer across. So she didn’t see my email I sent her as soon as I woke up to say I was alive and well. She didn’t know this until she saw my brief post here on this blog.
Around 4:30, I’ve finally urinated and they say I can go home soon. They phone Rachael to get the car and drive it around to the front, and they’ll wheel me out at 5. They won’t let me out of their sight until they see me getting into a vehicle driven by someone else.
Getting home is a memorable experience too. Rachael really hardly drives at all any more, and I’m not sure she’s driven since we left Tucson last winter. We considered getting a cab today, but she decided she was fine with it so I mapped out the quietest route home I could find - we don’t need to be merging onto a freeway at rush hour here - and for the next half hour we drive home, me playing navigator and coaching her along. When we get to our neighborhood we switch places and I drive the last few blocks. It’s hard enough for me to fit the Raven into a small parking space, so we don’t need to push our luck.
It’s pretty remarkable how normal I feel, though still pretty sedated. Rachael heads out to the store to get me a can of soup, and I spend much of the evening heading to the bathroom periodically for another brief, still stinging urination episode. We watch the next episode of Granchester, and before long it’s lights out.
Tomorrow, and tomorrow, and tomorrow
In the mail when we returned from Spain was a notification that Rachael has been summoned for jury duty - for a two day trial, starting two days before we’re due to leave Portland and head south for the winter. She phones me this morning at the coffee shop to discuss our timeline so she can submit her appeal to be exempted. Talking it over, I’m a little surprised to realize that when we leave Portland this time we plan to be gone for nearly all of the next year. We’ll be down south until about the first of February, and then if everything went well with my procedure we’ve been planning for another nine month Schengen Shuffle through Europe, leaving for Barcelona on around February 20th.
We’ll give it a few more days before looking for flights to Barcelona, but it looks like that plan’s a go. When Doctor Lin was going over the results of the procedure and we were discussing my post-op instructions and medications I told him that we were thinking we’d be leaving the country for nine months in February. He thought that would be fine, so there we are. In all likelihood we’ll be back in Portland in February for a brief time, maybe a week or ten days, and not return until late November next year.
So Bruce and I better get busy and fit in a few coffee dates soon.
The plan is still evolving a bit, but I expect it will look pretty much like this:
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We haven’t bought our flight yet, but the plan is to fly in, spend a couple of days settling in and seeing the city again, and then catching the ferry to Mallorca. I was surprised looking at the map to see that Mallorca is as close or closer to Barcelona than Valencia.
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I'm sure we will fit in a couple of coffee dates in the next three weeks. What I'm more worried about is fitting in a coffee date between Feb. 15th and 20th. It should actually be a dinner for the four of us since it will be about the only time we will see you next year.
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Looking forward to following along, once you get going, especially the AZ part... The Sonoran Desert is magnificent.
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