My Health Journey, ICU

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The last post was very long and concluded with me being awake in the ICU. This one will detail my stay in the ICU. We’ll start with an incident which occurred before I woke up, but took place in the ICU after the RTOR (if you don’t know what that acronym means, you didn’t read the last post…).

One of the things that was inserted into my body while I was in surgery was an external pacemaker. What? Yes, wires were attached to my heart. Those wires came out of my body (through an incision that they made precisely for this reason) and those wires were attached to a metallic black toddler-size shoe box. It was heavy. The box had a dial on it, where they could adjust the pacemaker, attempting to make my heart beat faster or slower.

While I was still unconscious, at some point, the doctors were nervously trying to adjust my heart rhythm. They were worried that it was too low. They kept turning the dial trying to get my heart to beat faster.

Luckily (for me), two things were true:

1) They did this in front of Lois and the two friends who were in the room with me (again, even though I had no idea)
2) I tend to go on (and on, and sometimes even more on…) about certain things.

One of those things is the fact that my normal resting heart rate (pre-surgery) was around 48 beats per minute (bpm). When sleeping, it could easily get down to the high 30s!

One of the people who had to endure my endless prattle about it is our very good friend Kevin, who happened to be there in the ICU while the doctors were nervously fiddling with the dial.

He was fascinated with the box and asked them what it was and what they were doing, and when they explained it to him, he informed them that my resting heart rate was typically in the upper 40s.

They stopped being nervous and stopped fiddling, and were satisfied that all was fine. I have no idea what would have happened if Kevin wasn’t there, or if he had stopped paying attention to my incessant prattling, but thank goodness he remembered and the doctors believed him!

Last thing to note before relating my awake experiences…

I’m generally not a fearful person and I typically don’t spend time worrying about things I can’t control. One major exception to that is a life-long fear of being catheterized in my nether region. For decades, it was an irrational fear, given that I’ve never had surgery, and there was no reason to expect that it would happen to me.

Yet, if someone even mentioned it in passing, or it was part of a scene on a fictional TV show/movie, I’d have a reaction, which was bordering on physical discomfort!

Before surgery, I asked a good friend who had been through many procedures, including open heart surgery twice, whether I would be catheterized (can you imagine how naive I was to think there was even a slight possibility that I wouldn’t be?). He said that of course I would be, and that it would be by far the least of the things I would be concerned about.

Of course, he was correct. In fact, once you are in the ICU for an extended period of time, you welcome the catheter, though only if they insert it while you’re unconscious, which thankfully was true for me.

Everyone in the Lenox Hill Hospital ICU was fantastic. Caring, communicative, upbeat, etc. You are completely dependent on them, so that’s a big win, to be taken care of by people who actually care.

There are basically three positions/activities that happen daily for an ambulatory patient. 1) lay flat on your back when you’re in bed, 2) sit in a chair most of the day, 3) walk back and forth in the hallway to get everything moving in your body and prove to them that you have your strength and mobility (or they won’t release you from the ICU).

Amazingly, they start the walking on day one, or at least they try to get the patients up and about on day one. Given that my main form of exercise are long walks (at high speed) and 50 flights of stairs once a week, I had no trouble doing the walk on the first day. The only annoying part of it is how many wires and tubes were still coming out of my body, that needed to be attached to a machine, which I pushed back and forth in the hall.

They were probably just being kind, but everyone who helped me walk, or even observed me walking, commented that they couldn’t believe how well I was doing on my first day. Of course, each day I did it multiple times and for longer and faster walks.

I was lucky enough to have near 100% visitor coverage during waking hours. Lois was there every day as were a number of friends. The days really went by quickly.

As I’ve mentioned a number of times already, I was a very poor sleeper. What I don’t recall mentioning is the fact that I couldn’t sleep on my back, even when I was willing to try for hours on end.

All of a sudden, that would become a critical skill to have, since you are not permitted to sleep on your side or stomach post open heart surgery, since your rib cage was sawed in half and needs to mend without the extra pressure of any kind of twist.

That turned out to not be the most critical thing, since sleeping in the ICU would be a good trick to pull off under any circumstances. Not only is there always something going on in the hall, but a few times every hour, there is something going on in your room!

People are constantly coming in and out of the room to check on the monitors and most importantly check on your catheter output and empty the bag if necessary. They wake you up a couple of times a night to take medicine (assuming you actually fell asleep).

Starting the second day, they also take a chest X-Ray in the middle of the night, every night, while you’re laying in bed on your back. Yes, they wake you (or the process wakes you if you happened to be asleep) in order to get it done. It’s fast and efficient (amazingly), but still, nighttime is not rest time…

I wasn’t really hungry, but they obviously want you to eat. I forced myself to eat breakfast and lunch, but often just picked at dinner. Surprisingly, the food was very good. I had a fruit plate every morning and salmon and sweet potato mash for lunch every day. I hope they serve the same food to the staff in the cafeteria, because it was quite well done.

For the first few days, there is literally no urge to move your bowels (or rather, I had no urge). That’s a blessing, in that the logistics of doing that in an ICU room are less than pleasant. Of course, I was forcing food down my throat daily, and it was definitely building up whether I wanted it to or not. At least the catheter took care of the other end…

On my third awake day (fourth day if you include the surgery day), the catheter came out. It was a very weird feeling, but surprisingly, it didn’t hurt. From that point on, I was mostly peeing into a plastic bottle, though occasionally I used an actual toilet.

I didn’t find out for another two days that I was still supposed to use the bottle, note how much I filled up, and only then spill it into the toilet. That became a bone of contention at the very end of my stay…

I had a couple of semi-successful movements as well, which were unpleasant to have to schedule (in the sense of requiring assistance to get to the toilet, due to all of the wires and tubes!).

The next day, the pacemaker wires were pulled out. Just like with the catheter, I was warned to brace myself, but ultimately, it didn’t hurt, it was just an extremely weird feeling.

I had four drainage tubes sticking out from the middle of my torso. Each had a rubber bulb on the end, to catch the fluid. They would empty those on a regular basis. The same day that the pacemaker wires came out, they also removed three of the four drainage tubes (leaving one in just in case). Once again, no pain but a very weird feeling (the tubes were much longer than you would think).

The next morning (fifth day out from surgery), they told me that there was a good chance that I would be released that day. I was surprised, because all of the pre-surgery information implied that you first get moved to a non-ICU room before finally getting released.

Apparently, I was doing well enough (with the walking and not having pain), that they thought it would be OK for me to go home (which I was extremely looking forward to). They took out the final drainage tube and monitored me closely for another hour to make sure there were no issues.

That morning was the only shift that I had a male nurse assigned to me. He was fantastic (as were all of the female nurses I had previously). Late in the morning, he brought in a bunch of release paperwork for me to sign. I was ecstatic.

Then we hit a snag. He said that before I could be released, I needed to void enough into the plastic bottle to empty my bladder. No matter how many times I tried, it wasn’t enough to satisfy him (by multiple orders of magnitude). He said that he couldn’t sign off on my release until I emptied my bladder.

I explained to him that the environment was not conducive to accomplish that, but that if I was home, and completely relaxed, I’d have success. In fact, I was specific in telling him that I felt that it was the physical pressure of the bladder and the rectum (sorry for being so graphic) pressing against each other, that was causing both ends to be uncooperative. I said that if one were to give, so would the other…

He remained unconvinced. Empty the bladder, or stay in the hospital. In fact, if I couldn’t empty it in the hospital either, it would likely require a catheterization again!

I told him that I understood, but that I would likely release myself against medical advice. He contacted the surgical team and asked them to weigh in. While we waited for them to make a decision (it took a couple of hours), he wheeled in an ultrasound machine and pressed it against my bladder, proving to me that it was nearly full to the brim.

When the surgical team arrived, they said that they would reluctantly release me, under the one condition that I would immediately return on my own to the hospital for catheterization, if I couldn’t void in the house after a reasonable amount of time. I promised, and I was released…

The next post will be about home recovery.