Send to KindleI ended the last post with a tiny spoiler, which is now memorialized in this post’s title. I’ll start with the final lead-up to the big day.
Exactly one week before the surgery (December 26th, 2024), I had to undergo a Cardiac Catheterization Test. It’s a procedure that let’s them look at the arteries around the heart to see whether there are any existing blockages, and to determine whether there might be complications during the surgery.
It’s an extraordinary procedure. If they had discovered a blockage, they could have inserted a stent right then, without having to open me up further than the tiny incision they made to insert the catheter.
If I didn’t need the ascending aorta replaced, they could have replaced my aortic valve with the same exact catheter procedure they were doing to simply look around!
The tiny incision was made on my right inner arm, right above my wrist. Thankfully, it worked, because the alternate entry point is the groin (not something I was excited to experience).
Most of my arteries were (are) clear, with a single one showing a 30% blockage, which the surgeons weren’t concerned about. My PCP on the other hand has flagged that as something that needs to be monitored over time, and is one of his major concerns over my cholesterol levels post surgery (we’ll get to that in a future post).
Prior to this test, if you had asked me if I had ever taken fentanyl, I would have definitively said no. To ensure that I didn’t experience any pain during the procedure, I was given a tiny dose of fentanyl (not enough to put me out, but enough to not feel more than “something is going on somewhere inside of me”).
In addition, I was given a dose of Midazolam. It’s meant to relax you when having minor surgery. It was explained to me that if anything traumatic happened during the surgery (psychologically, not physically), I would likely not remember it. Basically, it’s a feel good drug.
After the procedure, they monitor you in the hospital for a couple of hours, then make you walk for 30 minutes and void your bladder. If you can do all that, and not develop a bleed from the incision, they release you. I passed, I was released.
I don’t think I’ve mentioned this before, but prior to this, I never had any surgery of any kind (major or minor). I just passed the minor part, but was one week away from a more serious undertaking.
My last sip of liquor occurred on Christmas Eve (I’m a social drinker, never without company, so stopping that was trivial). I was cautioned to try and avoid as much contact with people as possible, since getting sick before surgery could throw the schedule off.
On January 1, 2025, one of our closest friends flew up from VA to stay with Lois while I recovered in the hospital. At the crack of dawn on the 2nd, the three of us got into a cab and went to Lenox Hill Hospital.
After filling out a lot of paperwork, I was taken into a pre-op room where my chest was shaved, and some areas in my nether regions as well, in case they needed to insert a cardiac catheter through my groin.
The anesthesiologist came in to explain to me what was about to happen. Shortly thereafter, I walked into the operating room and lay down on the table. The surgical team was already in there and scrubbed up.
At 7:30am, the anesthesiologist asked me where my favorite vacation spot was. I told him I was retired for a long time and my favorite spot was home. He asked me to imagine where I might want to go, and without much hesitation, I said Tahiti. He asked me to close my eyes and try to visualize what it would be like to be in Tahiti.
Within 10 seconds of closing my eyes, I have zero recollection of anything (including some pretty dramatic events) until I opened my eyes again in the ICU.
You might wonder how I know there were dramatic events if I have no recollection of them. In addition to being told about them by multiple people, I also read the chart in my patient portal where the surgeon detailed it as well.
I was in surgery for roughly five hours. During that time they replaced my aortic valve with a bovine valve (cow). I only found out two weeks later what that really means, and I will relate it in another post. They also replaced my ascending aorta, with a 100% synthetic one (also discovered two weeks later).
On to the part that I was told about but don’t remember. After the surgery, they wheeled me into the ICU. Apparently, I was responsive, though I couldn’t talk due to a breathing tube that was still fully inserted. I do not remember anything or anyone during that (very brief) time.
Lois, our friend from VA and a very good friend from NYC were all in the ICU room waiting for me. All three of them felt that I looked too pale (white as a ghost was one description), and were worried. A minute later the surgeons came in to check on me. They too weren’t comfortable with how I looked. They ordered me to be wheeled back into the operating room.
This is noted in my chart as RTOR (Return to OR!). They opened me up again, and quickly found a very small bleed. They closed that up and within 40 minutes, I was back in the ICU. Lois and friends said that I looked 100% better, with full color having returned that quickly.
I’m guessing that it was roughly 2pm on the 2nd at this point. I’m also guessing that they fully sedated me a second time to open me up and work on the bleed, which would explain why I didn’t open my eyes again until 5:15am on January 3rd, 2025. From my perspective, I was out for 21 hours and 45 minutes.
Given all of my multi-year sleep issues, that was the only glorious part of this entire experience.
On the other hand, waking up was one of the worst parts of the experience. I believed that I was fully prepared for my part of the waking up process, but I was wrong.
Before the surgery, Northwell Health requires you to watch two separate videos. They’re both on YouTube, so anyone can watch them. One basically shows you what happens inside your body (where the valve is, etc.). The other is a 13 minute video that shows you everything you will experience as a patient before and after surgery.
It’s an exceptional video and while I wasn’t looking forward to any of it, it was incredibly calming to know what the ICU room would look like, what the typical post-surgery challenges would be, etc.
One of the things they concentrate on is the waking up process. They show you a patient with a breathing tube in. They explain that it is important to get the breathing tube out as quickly as possible once you wake up. They prepare you well for what that entails (or so I thought!).
When I opened my eyes, I saw Lois sitting right next to my bed (she slept in the chair in my ICU room). There were at least three medical professionals standing over me as well. They explained that it was time to remove the breathing tube, and I nodded my understanding (it’s critical not to attempt to speak while it’s in!).
The procedure involves them pulling the tube out close to 90% of the way (I might be misremembering the exact percentage). Once it’s that far out, they require you (the patient) to breathe on your own. If you demonstrate that, they pull the tube out the rest of the way. I assume that if there are issues, they reinsert the tube.
I believed that I was breathing perfectly well on my own (and pretty proud of it!). Apparently, they didn’t perceive it the same way, and kept urging me to breathe. Unfortunately, the next part was excruciating…
The video never dealt with this, so I was unprepared for it and hadn’t warned anyone in advance. I have one of the worst gag reflexes of anyone I know. Now that the tube was 90% out, and I was breathing deeply on my own, I started to gag badly. I couldn’t explain to them what was happening, because I was disciplined enough not to speak.
When they asked “Are you OK?”, I violently shook my head “No!”. I was as close to a full-blown panic as you could be, while still sort of being in control (because I knew what was happening, though they didn’t).
No one in the room had the authority to simply pull the tube out the rest of the way! I heard them discuss it, and one of them left the room to find the person in charge of the floor to get permission. Unfortunately, that person was asleep (I blame no one, seriously!).
It took another few minutes of them trying desperately to calm me down saying things like “This isn’t unusual, lots of people go through this, try to relax and breathe, and we’ll be able to pull it out the rest of the way”. As soothing as the senior nurse was (and she was amazing to me throughout my stay in the ICU), it didn’t really help, because they didn’t know why I was having a problem.
At some point, I realized what was happening. I was breathing really deeply through my nose, feeling my belly fill up and rise, and then breathing it out, proudly. Whenever I did that, I could feel them tense up like something was wrong.
When I breathed through my mouth (which wasn’t often), I realized they were encouraged that things might be turning around. I tried to breathe only through my mouth, and sure enough, shortly thereafter they pulled the tube out completely. The nightmare was over.
In the next post, I’ll detail the recovery in the ICU.
Leave a Reply