Abe F. March

The 6th of May 2010 was my 49th wedding anniversary.  On that same date I had open-heart surgery. Both events were a matter of the heart.  The first event represented love and joy while the second event was necessary to continue the joy and love of life.

PART ONE

In April I had my annual physical and expected another good report,i.e., low cholesterol, maintaining good body weight, negative blood work, good EKG, etc.  When the doctor listened to my heartbeat, he lingered longer than usual and then said he was going to refer me to a heart specialist.  He heard, as he put it in German, a schussing sound that was not there on my previous examination.  His questions about getting tired or feeling pain in the heart area made me realize that those things were happening.  I had chalked it up to getting older and losing stamina.  As for the stich(sting) in the heart area, I figured it was heart pain associated with something I ate.  My doctor personally called and made an appointment for examination at the heart clinic in Landau,Germany.  I was not concerned and figured the exam would indicate everything was okay.

My wife accompanied me to the appointment. There was no waiting, and the examination with the ultrasound machine began. After the exam, the doctor didn’t hesitate, but said, “You need a heartvalve.”  The German word he used was klappe and I visualized the cat door I had made that allowed the cats to come and go as they pleased and the clapping sound it made.  But, it wasn’t amusing. In fact, I was stunned, and thought, “Me, need a heart valve?  A person who exercises daily?” When I asked him how this could have happened, he said that a virus might have caused it.  The doctor said it would require about 10 days in the hospital and then three weeks rehab.

“Three weeks rehab?” I exclaimed. His nurse assistant broke out laughing at my remark.  Perhaps it had something to do with the fact that her mother was American and she was familiar with US health insurance limitations.  I was somewhat perplexed since an operation would interfere with my summer plans.  My granddaughter was to fly to Germany for a visit with the stipulation that I would escort her back to the USA.  Due to summer vacation schedules, it would be a problem.  The second, but less  important problem was the choir concert where I was scheduled to sing a solo part.

I said that if it must be done, then I wanted to get it over with as soon as possible. 

The doctor then reviewed the problem of my aortic valve, how it had become enlarged and the pressure built up to force the valve to open.  He briefly discussed the two possibilities.The first option was a mechanical valve that would require daily medication for the rest of my life to prevent blood clotting, and would produce a clicking sound when the value opened and closed. The second possibility was a biological valve, predominantly taken from pigs, but there was a limited life span. Estimates ranged from 10 to 15 years. Considering my age, I decided to go with the biological valve. However,that decision was subject to change.

First the doctor wanted me for an overnight stay to do a catheterization in advance of the operation.  My wife and daughter accompanied me on my hospital check-in. 

As we waited, two nurses with grim faces pushed a gurney past us.  The body was completely covered with a small vase of flowers sitting on the chest. They told me that the procedure I was about to undergo had good success.  One in 10,000 were the odds that things could go wrong. Perhaps, I thought, this was the one that didn’t make it. 

Next, a lady who would prep me for the procedure cheerfully welcomed me.  She had a great smile and pleasing personality.  Having removed all my clothes and given me one of those mini-gowns that can be tied in the back, but never stay closed, I concluded that the smile may have had something to do with the fact that she was about to shave my groin.

The entire procedure took about two hours.  They did a local anesthetic with some form of relaxant, but I was awake and aware of what was happening. It was a bit scary feeling the tube progressing from the groin up to the heart.  Then two more passes to insert “stents” where weak veins were inhibiting blood flow. 

Afterwards, I had to lie on my back and keep my right leg straight for an uncomfortable six hours.  It was along restless night.  Frequent bloodpressure measurements and EKGs, nurses lifting the covers and taking a peek at my groin exclaiming, “looking good”.  Oc ourse I knew they were referring to the entry point of the wound.

Before discharge, I met with the doctor and was told that everything went well.  He said he would arrange for the heart valve replacement operation to take place at the heart clinic in  Karlsruhe.  He said there was a possibility that cutting the chest open for the operation could be avoided with a procedure using “stent graft prosthesis.” That would be decided in Karlsruhe. 

I was given an appointment to return the following week for a headscan.  In the meanwhile, I made an appointment with my family doctor.  He would make arrangements for eye, ear, nose, throat and teeth examinations prior to the operation to avoid any side complications, and two teeth were pulled. 

PART TWO

The date of the hospital admission in Karlsruhe was set for the 4th of May.  I expected the operation would take place on the 5th, but further testing was done on the 4th that indicated a heart by-pass would also be needed.  The date for the operation was set for the 6th of May,the date of my wedding anniversary.    

On the morning of May 6th, I was prepped and rolled into the operating room.  Using the stent graftprosthesis procedure was out of the question: open-heart surgery was required.  After consultation with a doctor, I decided to go with the biological valve.  I was already relaxed from medication and don’t remember much from that point until I began seeing shapes around me as I came out of the anesthesia and was rolled into intensive care. There was something very strange happening to me.  I thought perhaps I was remembering a dream,and if it was a dream, it was very real. My brother-in-law in Pennsylvania had passed away just a year earlier from complications resulting from hospital surgery.  He went into the hospital for a back operation, and after being closed-up, they discovered internal bleeding. They waited for him to regain strength before re-opening, however in the meantime, he became weaker, caught pneumonia and died.  He was just 73 years of age.  My apprehension about the operation may have been heightened due to thoughts about surgical foul-ups.  Whatever the cause, I don’t know if I was dreaming or if what I saw was real.  I saw myself lying on the operating table with the doctors working on me.  My brother-in-law appeared in the room,walked over to me and placed his hand on my shoulder.  He said, “Don’t worry Abe, you’re going to make it.”  Then he faded away. 

I don’t know why, but once I was placed in IC I was given a blood transfusion.  My wife came to visit as soon as allowed andwished me a belated Happy Anniversary.   

Although most of the nurses in the IC unit were very good, I felt helpless and vulnerable.  One young male nurse made me extremely nervous.  He was a trainee, and his trainer watched what he did – at least most of the time.  He was nervous, and it showed.  That made me nervous.  He had the features of a Negro, was tan but not black.  I asked him if he spoke English and he said, “a little,” but didn’t try to speak it.  It occurred to me that he may have been the result of an American GI who left a child behind before leaving Germany, and that he might resent Americans, and I became fearful, especially in my helpless state.  When he washed me, he let me lay exposed.  I tried pulling the sheet ove rmy privates but couldn’t do it.  I was not only fearful that he may do something wrong, but also felt that he took a   bit too long when washing my privates. I didn’t want him around me.  I expressed my concern to a female nurse saying that I was nervous when he was around and would prefer someone else to attend me.  I never saw him after that. 

The second isolated incident was with a night nurse in the IC unit.  Sleeping on my back caused me to breath through my mouth and it was constantly dry. I took frequent sips of water to relieve the dryness.  Being connected with tubes for both stool and urine, the water bag may have caused this nurse to admonish me frequently saying, “Mr. March, you are drinking too much water.”  On this particular night, I was in much pain and pressed the call button.  This same nurse appeared and I told her that I needed something for pain. She said, “Mr. March, I am making my rounds and will be back in 20 minutes.”

“I need something now,” I replied. She repeated her statement about making her rounds and coming back in twenty minutes.  It occurred to me that she could have given me the medication during the time she was making her excuse.  Those twenty minutes seemed very long, and the pain intensified. When she finally gave me the pain medication I was angry.  Subsequently, I didn’t make eye contact with her.  On the next shift, I said to another nurse, “Not all nurses are the same.” Smiling she replied, “True.  And not all patients are the same either.”  I explained that a particular nurse had given me the inspiration to write a story.  Copies of my published books were on my bedside table, and it became known that I was an author.  When the doctors made their morning rounds, one told the others that I was a Schriftsteller,a writer/author.  I felt good about being an author. 

Before the operation, I had finished reading the book, “Secrets” byDeepak Chopra.  I was impressed with the author and my daughter brought another of his books along when I was dropped off at the hospital.  The book she gave me was “Life after Death.”  When I saw the title my facial expression reflected some puzzlement.  My daughter then realized the inference and wanted to take the book back.  I insisted that it was okay and kept the book. As it turns out, it is a very good book and one I can recommend.

After 3 ½ days in IC, I was moved to another floor for a regular room.  There was a sitting area dividing the two-room complex with a table for taking meals or entertaining guests.  On both sides of this area was a spacious room accommodating two patients.  The nursing staff did everything to make me comfortable and checked frequently to see if I needed anything.  Unfortunately one cannot choose a roommate.  Mine was very talkative and seemed to enjoy farting, after which he would utter a huge “Aaaah” of relief.  Lying on my back meant that I most likely also snored.  I was not prepared for the snoring of my roommate accompanied with loud gasps for breath.  Sleeping and pain pills did not provide a good night’s rest.  I tried to tune out the babbling of my roommate whose dialect was difficult to understand,and the nonsense he spoke was tiresome. I responded with lots of “uh-huh’s” without knowing what he was talking about, and it seemed to satisfy him.

A patient in the room on the other side of the sitting area was scheduled to leave for rehab on the same day as me and we had chosen the same facility.  On his final exam it was determined that the sutures tying the valve in place were leaking.  They decided to re-open his chest and re-sew the valve.  We sat together at the table for our meals, and on our last evening together, I said it would be great to have a beer.  My three patient companions agreed, but laughed at the idea. When the nurse returned to pick up the food trays, I asked, “Could we have a beer?”  She said, “Yes.  Will that be four then?”

I said, “Alcohol free or real beer?”

She said, “Either. Your choice.” So we all enjoyed a beer.

I had a choice of three rehab locations.  The rehab facility I chose was purely based on convenience for visitation and the single rooms shown in their brochure.  I was picked up by the rehab clinic’s van and transported to the Park-Klinik in Bad Dürkheim I was very tired and looked forward to a quiet evening, unpacking and relaxing.  When I was shown to my room it was a double room with another occupant.  Surely this was a mistake, soI checked with the receptionist only to be told it was no mistake.  The first floor provided round the clock care and new patients requiring special care were placed there before moving into a single room.

It soon became clear that this rehab facility catered primarily to people with bone and joint problems. Eighty to ninety percent of the people were either on crutches, wheelchairs or walking with a rollator (walker).  I received a schedule for participation in daily rehab activities. Breathing exercises, inhalation, simple body exercises and massages were part of the therapy.  

I developed a severe case of bladder blockage combined with stool hardening.  The pain was severe.  I told the nurse that I couldn’t urinate.  She placed me in an examining room and called a doctor – at least that’s what his nametag suggested.  Having explained my dilemma, he seemed puzzled.  The first thing he did was to take some blood.  His first attempt,poking twice in the same vein, produced nothing, so he tried a vein in the back of my hand.  I wondered how taking blood would alleviate the problem with my bladder. He succeeded in causing more pain. Then he opened the doors to the medicine cabinet and surveyed its contents.  It appeared that he was still trying to figure out what to do.  He picked up a tube, examined it, put it back and looked at other items.  At that moment, a nurse came into the room and asked about the problem.  She selected a catheter and inserted it into my penis.  There was immediate release and relief as the urine began to drain and the pain subsided.  I have no  idea what the doctor would have done if the nurse hadn’t come to his aid.  He was obviously some intern and his days of practicing medicine had just begun.

The heart patients were in the minority and it seemed to me that they were not given as much attention as other patients.  After six days I was moved to my own room with TV and telephone.  The restaurant served good food and the big meal of the day was at noon - a German tradition.  Getting through the buffet line was not always easy when following those on crutches or rollators.  I thought Americans had large rear ends, but came to realize that Germany is catching up. I don’t know if many of the problems with the knees/legs were caused by overweight or if overweight resulted from problems with the knees/legs. 

My doctor found it curious that I was American and informed me that there was another American at the clinic and introduced us.  This American lived in Germany for thirty some years and was now a widower.  I soon became bored with him and ticked-off at his attitude.  He seemed to enjoy medical attention and a free ride.  His conversations centered on how clever he was and how he was able to exploit the health care system.  He was already on an extension at rehab and sought another.  He faked a blackout and said that they couldn’t send him home after that, however I think they got wise to him and he departed two days before my release. 

I was transported by the clinic to my homeon the 7th of June.