JUNE 2018: Notes from the Heart, Part 2; The Procedure

JUNE 2018: Notes from the Heart, Part 2; The Procedure
May 31, 2018 leonard slatkin

Musicians hate, really hate, getting up early in the morning. That is why orchestra rehearsals don’t start until around 10 a.m. So I felt both lethargy and anxiety when I arrived at the University of Michigan Medical Center at 5:30 a.m. to begin preparations for the day’s events.

After the tests that were given the day before, I received clearance to move forward with the procedure. It struck me as odd that I had to pass tests to determine if I was well enough to fix a major disease. What would have happened if I had a cold, or worse? Knowing that the blockage in my arteries was above 90%, it was not impossible to envision another heart attack while waiting to recover from an unrelated illness.

Getting ready for surgery can be an exercise in patience for the patient. In this case it was a much longer wait than usual. As I was led to the pre-surgery area, I was informed that my doctor was called in for an emergency heart transplant and that my own procedure would be delayed for three or four hours. The originally scheduled time was 8:00, so now it would not take place until after noon.

I don’t know how many people work at the hospital, but I think I must have seen at least half of them while waiting to be wheeled into the surgical theater. To start off with, I was handed the items I needed to wear, including that awkward dressing gown. It was never in my repertoire to tie anything behind my back. I must have spent ten minutes getting it fastened. Then I had to lie down on the bed, where I would spend untold hours on my back.

Almost every ten minutes someone would come in to take “vitals,” including blood oxygen, blood pressure, blood sugar, and temperature checks, in addition to giving me an EKG. I never got an answer to the following question: “If it is an electrocardiogram, why is there a K in the abbreviation?” Another annoyance was that each person always started by asking me my name and birthdate. It was clear why all these precautions were necessary, but I would rather have gone back to sleep after the short night.

A port was put into my hand, enabling all meds and fluids to move into me throughout the stay.  It became impossible to figure out what the various people did as they paraded in and out of the pre-op room. Nurses, anesthesia specialists, surgeons, assisting surgeons, and so many others passed through. Just for a change of pace, I gave my name as Herbert von Karajan. But I did not remember his birthday and returned to my own identity.

The hours dragged on, but finally, around 2:00 in the afternoon, I was whisked off. It was just like in the TV shows and movies with the POV from the patient’s angle. All you see is the ceiling and those bright fluorescent lights. Then you get to the operating room, which looks like something out of a sci-fi production, all in white. There must have been ten medical personnel in there, all very busy. Finally, my surgeon came up to say hello and that he would see me later. A few seconds after that, I was asleep.

What was going to take place?

A coronary bypass sounds a bit more pleasant than open-heart surgery, but they are pretty much the same thing. And the word bypass is exactly what was about to occur. Rather than putting stents in the offending artery, a blood vessel is taken from the leg, in my case, and connected to the other arteries in the heart, getting the blood around the problem and into my system.

Anyone remember the Johnny Carson bit when he played Art Fern, the obnoxious salesman? His catch phrase when describing how to get to his place of business was, “Take the Santa Monica freeway to the Slauson cutoff and cut off your Slauson.” That is pretty much what was going to occur in my body.

An incision was made in the groin area, and a camera went up there to look around. It had not yet been determined exactly what type of procedure would be used, and this gave the doctors time to discuss and evaluate. They determined that a triple bypass was the way to go. Another deeper cut was made in the chest area, and then they broke the sternum and pulled it in half. The heart was completely exposed. Now comes the weird part.

In order to do this correctly, they have to stop the heart from beating for a couple minutes. A tube is put down the trachea, and the 21st-century version of an iron lung is used to keep the patient breathing. Then a blood vessel is taken from the leg, subdivided, and put in place so that the blood can flow from the heart to the arteries without any blockage. The heart is restarted at some point, and when the surgeons are sure that they covered all the bases, they sew everything back up.

Clearly, and thankfully, I was asleep for all this. As much as I enjoy a good Tarantino film, it is another matter entirely when the person oozing plasma is me. The actual procedure took about four hours. I continued my cat nap for another couple hours until someone woke me up. At that point I had been transferred to the ICU. Cindy was waiting anxiously and had been informed along the way what was occurring. All I really remember is that I was hooked up to a number of machines and seemed to have as many tubes in me as an old Philco radio. I did not feel much of anything due to some opioids, showing me that despite the continuing crisis of overuse in our country, they can actually help.

The surgical team came in to tell me what they had done. It would be the only night that I would stay in intensive care, being monitored constantly. The most annoying of the tubes, the one put down my throat, was taken out after it was deemed that I could breathe on my own. Everything else stayed in place.

There was no sleep that night. Nessun Dorma. The combination of drugs, the constant comings and goings of medical attendants, and the whirring and beeping of all the machines made heading to the Land of Nod impossible. In my dazed state, very little of this 24-hour period remained embedded in my mind. But by the next day, when I was moved to a private room, things changed.

Stay tuned.