Ten million and counting

I had a change of heart a few months ago. Actually, what happened was I got a new mitral valve, and it changed my life (Figure 1). During the procedure, minimally invasive open-heart surgery, the cardiovascular surgeon made a five-cm incision between a couple of ribs on the right side of my chest. Then he opened my heart and cut out the diseased mitral valve. The old valve was scarred and narrowed from progressive mitral stenosis, a consequence of rheumatic fever when I was a kid. The surgeon and his team sewed a slippery new pyrolytic carbon valve into the space between my left atrium and left ventricle.

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Figure 1:

A change of heart.

Photograph by Teresa Hanlon

It sounds straightforward but in reality is a miracle of medical expertise, teamwork and technology. From start to finish the operation took about five hours. For two hours of that time, my heart stood still, given that it’s technically challenging to sew on a moving target.

A few weeks before surgery, a friend asked if I could do him a favour during the time my heart was stopped. While I was “over there,” he asked, could I look around for the winning numbers in the upcoming Lotto Max and bring them back for him? As sure as my middle name is Maximilian, I told my friend I would do my best.

Days later, as I was regaining consciousness in the ICU after surgery, I recall speaking a series of numbers to my spouse and asking her to email them to my friend. Two days later, I received his brief reply: “Perhaps those numbers were for a different day.”

My failure to get my hands on that winning combination foreshadowed my stumbling recovery.

Post-op day 1, my surgeon visited me in the ICU to say things had gone well. He described some technical difficulties due to residual scarring from my first open-heart surgery 40 years ago. I found his relaxed, unhurried demeanour and candid description of the surgery reassuring. He said he’d see me in six weeks. A smooth and effortless recovery was just six short weeks away.

During our telephone consent conversation weeks before the surgery, we had discussed some of the things that could go wrong: bleeding, stroke, clotting on the new valve, infection. Some scary stuff, but those things happen infrequently. We agreed it was time to replace the valve, to halt the ongoing deterioration in my heart–lung function (a.k.a., pulmonary hypertension).

I don’t remember discussing the work of recovery during that call. It is work to move from point A — an unconscious patient with a new valve in a silent, motionless heart — to Point B — a 70-year-old guy cycling once again to Sonder Cafe, with joy and ease. The work I would need to do to regain what Rebecca Solnit calls, in Wanderlust: A History of Walking, the “vital body in action.”1

On a Sunday afternoon three days after surgery, I was ready for discharge. The physiotherapist told me to expect physical improvement of 1% a day. That would mean that it would be 100 days, or just over three months, before I’d be back to cycling and swimming. But first, there were 11 hindrances in need of healing. Eleven cuts or punctures had allowed instruments, tools and devices into my body: the scalpel for the opening incision, chest tubes, thoracoscope, central line, pacemaker, a handful of shorter and longer catheters for intravenous and intra-arterial access, and pain control. And there was another pressing hindrance as well, this one psychological as much as physical: I needed to survive 30 days in order to claim my critical illness insurance benefit. Cue the Bee Gees singing “Stayin’ Alive.”

Recovery started out well, but then on day 15, I was blindsided by Amaurosis fugax, a temporary loss of vision. Within minutes I lost and then regained sight in my right eye. Nearly a stroke to that eye. Hasty discussions with members of my medical team ensued; we decided to add a baby Aspirin daily to the blood thinner I was already taking. Cue Johnny Nash, “I Can See Clearly Now.”

Closing in on survival day 30, I spent an afternoon in diagnostic imaging at my local hospital, where one of the radiologists inserted a catheter into my chest and drained nearly two litres of fluid (a.k.a., thoracentesis for large right pleural effusion). I don’t recommend it as a strategy for weight loss. Afterward, I did sleep easier, as my need to get up to pee several times each night disappeared. Getting rid of that extra fluid also diminished my persistent nausea, improved my appetite and gave a modest boost to my joie de vivre (Figure 2).

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Figure 2:

The author takes the first steps toward a full recovery, intravenous in tow.

Photograph by Sebastian Hanlon

I was relieved to make the 30-day deadline, but then a month later, the surgeon and I had to address another residual fluid collection: an egg-sized lump in my right groin (a.k.a., a lymphocele) at the site of access for the cardiac bypass lines. After two failed attempts to drain “the egg,” my surgeon decided to explore and repair it. That new wound took more than a month to heal. During those days, I couldn’t flex my right hip without discomfort, or bend over to put on a sock or tie my right shoe. Stairs were a challenge. I limited walking to essential steps.

At the three-month mark, the cafe was still discouragingly out of reach. Prolonged inactivity takes its toll; strength, flexibility, mobility, coordination and confidence melt away. I desperately missed my daily routines of walking, swimming, biking, Ping-Pong and stretching. I began my 12 weeks of supervised exercise (a.k.a., cardiac rehab). Twice a week I walked and spin-biked while Bach’s Goldberg Variations played in my hearing aids. I stretched, lifted weights and recorded my irregular pulse and oxygen saturation in the good company of other former patients and enthusiastic staff. This is not a solo journey. Together we were committed to our best individual recoveries. The new valve was a gift — it has opened and closed more than 10 million times since day 1. The encouraging presence of my rehab teammates was extraordinary.

Was there a turning point in the journey from Point A to Point B? Fourteen impatient weeks after surgery, I did return to my local pool for a swim. Pushing off from the wall, I immediately rediscovered the delight of near weightlessness. I was surprised how quickly my arms, legs, head, trunk and breathing began working together again. I wasn’t in the water very long before an habitual lane-swimming ritual in my head kicked in. I thought of different friends, my grandchildren and members of my medical team as I slowly made my way up and down the lane. Each stroke is a stretch, a grateful reaching forward with open hands to reclaim my active life.