CABG surgery plus nine days

Final blood tests done. Discharge medications received. X-ray films too. Outpatient cardiac rehabilitation (at The Royal Melbourne Hospital starting in a week) organised. Review appointments by cardiologist and heart surgeon fixed. Final physiotherapy and dietitian sessions attended. Patient Cardiocard received. Discharge Instruction Summary signed. Big bag of chocolates plus a card bearing Sweetheart Vivienne’s heartfelt (pun intended) words To the amazing team on the 5th floor. From Ross and his grateful family. Thanks! presented to the staff.

So…Farmdoc leaves the hospital. Reverts from a patient back to a person. Deliberately. Eagerly. Meaningfully.

Due to a 2 kg lifting limit, unable to carry his bags. So his long-time friend Peter – Melbourne’s best physician – carries them. Poignantly.

Met in the Admission/Discharge Office, then walked to the car, by darling Kate. Unforgettably [1]. Met beside the car by Sweetheart Vivienne [2] and darling Indi. Lovingly.

Home Sweet Home. A cliché. But a welcome reality too.

The first day of the rest of my life.

CABG surgery plus four days

The ICU staff must have been pleased with my progress because around lunchtime today I was transferred back down to the 5th floor cardiac surgery ward. I felt like I was on a 5th/7th floor yoyo. To the left of my 5th floor bed was a west-facing window overlooking the University High School oval where in 1970 as a junior doctor at the adjacent Royal Melbourne Hospital I’d run laps before work. Though then I was young and fit and now I was old and I could hardly walk, for some reason I thought that a good omen. Another good omen was that one of the 5th floor nurses introduced herself to me as Leanne. And she told me she was CEO of the entire Melbourne Private Hospital. She said she was working on the ward because of short-staffing. Even so, I was mightily impressed that the CEO was doing hands-on patient work. (It reminded me that in the old days when Bob Ansett ran Budget Rent A Car, he rostered himself and all his executives to work on customer contact jobs one day per week.) Anyway I told Leanne the story of my missing wedding ring. And she promised me she’d make enquiries. I was hopeful it’d be found. But today being Friday 13th, I wasn’t optimistic.

CABG surgery plus three days

I spent all of today in the ICU – under close medical and nursing scrutiny. I had a few runs of AF. But none rapid and/or long. I was in a single room. I slept most of the day. That two hours of earthquake AF last night knocked the stuffing out of me. I was exhausted. And because today was only the third post-operative day, I was coming off a low base of energy and endurance.

CABG surgery plus two days

My wedding ring had been taped on pre-operatively. I didn’t know who’d removed it. Or why. And, more importantly, I didn’t know where it was. At this critical time, when I needed to feel so connected to Sweethert Vivienne, the absence of my wedding ring seemed a major portent. But with two lower chest draintubes, arterial or venous lines in my left neck and right elbow and left groin, an indwelling urinary catheter, long scars over my midline chest and front of left forearm, heart pacing wires coming from my chest, 12 leads taped to my skin for heart monitoring, and doped up with strong medications I was clearly unable to engage in any wedding ring detective work. That would have to wait for later. By lunchtime Wednesday – 20 hours since I regained consciousness (or at least sustained memory of it), I was ready to be moved from the 7th floor ICU to the 5th floor cardiac surgery ward. The transfer occurred about mid-day. Just after I presented the ICU staff with a ‘thank you’ bag of Haigh’s Chocolates [1]. A few hours later – Wednesday mid-evening – I, my bed, the ward, and even the hospital, began to shake. Violently. Irregularly. And they didn’t stop. It turned out I’d developed an irregular heart beat, called atrial fibrillation [AF]. It’s a known complication of CABG surgery, occurring in 40-60% of cases, and due to heart swelling during the surgery. It resulted in my immediate transfer back up to the ICU. It took a while to be controlled. My heart rate was over 200 per minute for over two hours. Eventually it settled. Everything stopped shaking. And my anxiety dissolved away.

CABG surgery plus one day

As if through a fog, a haze, a cloud, my consciousness returned. When it reached a certain threshold, the first thing I did was make sure my four limbs worked. They sure did. Next I checked my cognitive function. How? By thinking of the years of Collingwood premierships in my lifetime. (For the benefit of infidels: 1953, 1958, 1990 and 2010.) Thus I’d escaped the known heart surgery complication of stroke. Great news. I also quickly noticed my endotracheal tube had been removed from my throat. This buoyed me further: the literature and films I’d seen pre-operatively were unanimous that waking up with a tube down the throat – causing gagging and preventing talking – was the most lingering post-operative memory. I could tell I was in the Intensive Care Unit. (The previous evening I’d visited the ICU for a brief familiarisation tour.) There was a big round clock on the wall in front of me. It read 4 o’clock. I didn’t know which day it was let alone if it was 4 a.m. or 4 p.m. My nurse told me it was 4 a.m. on Tuesday 10 May. (This was about 16 hours after when I thought the surgery began.) I lay there content. Or at least inert. In no pain. And then I discovered my wedding ring wasn’t on my left ring finger.

CABG surgery day

Yesterday mid-afternoon darling Emily drove Sweetheart Vivienne and me to the Melbourne Private Hospital [1]. A few minutes later, the paperwork had been done and we were in the ward. I had a chest x-ray and some blood tests. Then in the late afternoon we met my surgeon Mr Goldblatt. For the first time. In a gentle, unrushed and authoritative way, he explained to us what happens before, during and after the surgery. I quickly decided I had confidence in this man. Soon after, Sweetheart Vivienne left – with darlings Sue and Jeffrey who drove her home. Later the anaesthetist visited. During her stay the information flow was almost all from me to her. After she left, my arms, legs and chest were shaved. Then I showered, during which I scrubbed myself with iodine antimicrobial foam. Then I donned my pyjamas – the final symbol of my conversion from person to patient. Then I hopped into bed.

Today was CABG surgery day. I woke early. After a good sleep – courtesy of tablets. I had another shower including a further iodine foam scrub. And I donned one of those awful hospital gowns. No breakfast for me, of course. I was in the pre-operative fasting stage. The perfusionist (who was to operate the heart-lung machine keeping me alive when my heart would be stopped during the operation) called by. To bid me g’day. I remember saying I hoped he was in top form. And that he replied he was.

I was warmed by the thought that all day, three of our darling daughters would be physically with Sweetheart Vivienne. And the fourth – in the USA – would be with them in spirit.
Farmdoc’s Blog readers know my dad had clinical heart disease since his early 40s, and a heart attack killed him at age 56 [2]. (Then, in 1969, CABG surgery wasn't available.) Funny thing. All morning this morning I wasn’t Farmdoc. Nor was I Ross. I was Inigo Montoya – hero of the 1987 film The Princess Bride [3]. And continuously, as if on a tape loop, was Montoya’s oft-stated threat: Hello. My name is Inigo Montoya. You killed my father. Prepare to die. [4] The heart disease that killed my father, and that was afflicting me, was about to be conquered. Not by Montoya’s sword. But by Goldblatt’s knife. (That Sweetheart Vivienne’s my Princess Bride's also relevant, of course.)

Late morning a nurse came to give me a morphine injection. And that’s my last pre-operative memory.

CABG surgery minus one day

This afternoon at 2 p.m. I’m being admitted to hospital. Currently my world’s small. Focused in on myself. Which isn’t something I relish. But I suppose in the circumstances it’s inevitable. Beyond my solipsism, today’s Mother’s Day in Australia. So I’m especially thinking of my own mum, and the nearest and dearest mums to me. Not least Sweetheart Vivienne – who’s one of the best. Today’s also the first post Bin Laden Sunday. I can’t help but think our little planet’s a tad better off for that fact. Otherwise all else continues: football matches, political intrigue, celebrity worship, global warming, and more. Including the federal budget next Tuesday evening. But for me, it’s hospital. Speaking of which, I know that while hospitals are necessary institutions, it’s best to be a patient in one for as short a time as possible. Which is my aim in the days ahead. I don’t know when my next Farmdoc’s Blog post will go up. Hopefully soon. Stay tuned, folks.

CABG surgery minus two days

A quiet day today. A stroll to Victoria Market with Sweetheart Vivienne. A long chat with Sweetheart Vivienne and darling Emily over brunch. A look at some surveillance video then a quick 2-page report on its content and implications. A skype video conversation with darling sister Sue and brother-in-law Jeffrey. Then a visit to long-time friends Peter and Vonne. Busy, busy. So not much time to think about my hospital admission tomorrow let alone the surgery on Monday. It’s hard to know if I’m getting closer to these events or they’re getting closer to me. Whichever or both is so, I feel strangely calm about it all. Why ‘strangely’? Because I reckon I should feel anxious. What’s about to happen is big. Bloody big. But my mindset remains positive. Optimistic. Which is strange for the cup-half-empty bloke that I am. Tomorrow? That’s another day. Today I’m okay. Really okay.

P.S. Thank you to those who wrote such supportive and comforting comments on yesterday’s post. It’s trite to write it, but I’m sincerely grateful to each of you. Also to Sweetheart Vivienne [1] and darling Kate [2] for blogging about me so lovingly. What a support team I have. I am a truly blessed man.

Farmdoc rides again.

On Sunday I’m being admitted to the Melbourne Private Hospital. Then on Monday I’m having coronary artery bypass graft [CABG] surgery. It’s major. Seminal. Existential. For me. And also for my darling family and my friends. Even in some way for my acquaintances. So I need to write about it: to consider it. To weigh it. And of course to record it. What better way to do all this than Farmdoc’s Blog. So the journey begins. Actually, no. It began a year ago when I began feeling an ache behind my chest bone. It was exercise-related then. And it’s remained so since. At first I thought the cause was the hiatus hernia I knew I had. So I took Nexium. It helped. But not totally. Long story short, on 14 April I had a treadmill exercise test which showed I had a heart problem. Then on 27 April an angiogram revealed severe disease of all three main coronary arteries. Indeed so severe it wasn’t amenable to angioplasty. Therefore it’s CABG surgery for me. Given my family history, I’ve long thought coronary artery disease was in my future. For decades I’ve been trying to avoid it by attending to all the known risk factors. I may have delayed it. But I couldn’t outrun my chromosomes. With Sweetheart Vivienne I’ve been walking: 3-4 km each day. So I’m physically ready for surgery. I’m psychologically ready too. I’m focused and determined. Oh I expect rough times ahead. But I know I’ll get there. And so, it seems, do all the people mentioned above. I’m overwhelmed, and humbled, by their love, care, wishes, and in some cases prayers. I’m ready. Bring it on.

P.S. I hope to put up daily posts. The first few will be retrospective. They’ll cover medical matters. But more so my thoughts, my anxieties and hopefully my triumphs. I invite you to share my journey. If you’re up for it, to paraphrase the bumper sticker: Log on, sit down, buckle up and hang on. We’re going to hell and back. Farmdoc rides again!

The last post

Dear Farmdoc’s Blog followers and readers

The first post on this blog was way back on 21 April 2008 [1]. Three years ago tomorrow. Since then I’ve put up one new post each day. So today’s post is number 1,095. And for the time being at least, and maybe forever, the last post. There are three main reasons for this:

1. A post a day’s a big undertaking. For me anyway. I’ve enjoyed doing it. But in recent months it’s become more arduous. And less fun.

2. Last week I received some not-so-good health news. Currently I don’t know its full import. But whatever it turns out to be, I have much thinking to do. And I know I’ll think better without the pressure of a daily Farmdoc’s Blog post weighing on my mind.

3. Because of that news, Sweetheart Vivienne and I have decided to sell our Mole Creek property as soon as we reasonably can, and then move to Victoria near our darling ones. So we’re starting work on a new blog – as yet untitled – aiming to attract a purchaser. And most definitely I can’t maintain two blogs simultaneously.

In that first post I wrote that writing Farmdoc’s Blog would help me find out about myself ‘And if it also helps others, in however small a way, then that can only be a good thing’. I know I’ve achieved that first aim. The second one I don’t know about.

On 27 September 2009 I wrote a post about the Last Post. In a comment on it, darling Meg wrote ‘FD you gave me the fright of my life! I saw the words last post and I thought that you were henceforth taking leave from your blog’ [2].

Friends, the time’s come for me to take leave from this blog. I plan to put up one more Farmdoc’s Blog post in the next couple of months – when our new blog goes live. After then, who knows?

So there you have it.

Thank you for accompanying me on my journey.

Farmdoc.

P.S. I remain contactable at the email address in my Blogger profile.

Review Tuesday: 'Not your ordinary doctor'

Today’s ‘Review Tuesday’. A fortnight ago I reviewed The Pen & the Stethoscope – a collection of short stories all written by doctors [1]. As chance – or perhaps grand design – would have it, of the several library books I had on order, the one that arrived next for me was on a somewhat related topic. Not your ordinary doctor is a 346-page 2010 non-fiction book about doctors who’ve also pursued non-medical fields of endeavour [2, 3]. In most cases their non-medical fame (or notoriety) exceeded their medical repute; in other cases vice versa. Author Dr Jim Leavesley tells the stories of sixty ‘medical truants’ comprising doctors to royalty and national leaders; doctors in the arts; doctors who’ve been adventurers, inventors, athletes or politicians; and doctors who’ve been criminals. Several of their names are well known – including Aristotle, Keats, Maugham, Roget, Borodin, Conan Doyle, Chekhov, Gatling, Bass, Livingstone, Grace, Bannister, Montessori, Crippen – and some not. Only a few are Australians. Only a few are women. And only a few are contemporary. This is the eleventh book written by Dr Leavesley (who since 1986 has been an accomplished and loved ABC broadcaster) [4]. He writes nicely. But all too often excessive factual detail distracts from his main theme. Yet overall this is book’s fascinating. And its 16 cm square format’s refreshingly different. Though the cover photograph relevance escapes me. Ho hum.

Cheered up by 'The Australian Medical Dictionary'

Subculture. thefreedictionary.com defines it as ‘a cultural subgroup differentiated by…factors that functionally unify the group and act collectively on each member’ [1]. According to this definition, the medical profession’s a subculture – even though it’s not on Wikipedia’s list of subcultures [2]. One factor delineating a subculture’s a unique vocabulary. Medicine has one. Well, two actually. One’s the official one comprising orthodox medical terminology. And the other’s an unofficial one – that’s known to medical practitioners but not to non-medical people. In general its words, phrases and acronyms are irreverent at best, insulting at worst, and non politically correct always. Also funny. Very funny. Here’s a BBC article from 2003 explaining what I mean [3]. Segueing slightly on from there, is a list of words published in the April 2011 issue of Australian Medicine. Titled ‘The Australian Medical Dictionary’, it comprises definitions of medical terms [4]. But these definitions are funny. No – they’re hilarious. To me, anyway. I wish I had the wit to compose definitions like these. After the week I had last week, ‘The Australian Medical Dictionary’ has helped cheer me up. That’s for sure.

Call Yachol - a wonderful business

Today’s ‘Positive and Optimistic Sunday’. Indeed today’s the sixth consecutive ‘Positive and Optimistic Sunday’ post about Israel. No apology from me for that. All six topics are clearly positive and optimistic. None more so than today’s. Call Yachol is an Israeli call centre and outsourcing company [1]. Set up in 2008, Call Yachol’s the brainchild of psychologist Gil Winch. It’s unique in the world – because it employs disabled adults (aged 20-65 and with no cognitive impairment). Including more than a few Israeli Arabs. In Hebrew, Call Yachol means ‘able to call’, and also ‘able to do anything’. Which is precisely what the more than 100 disabled team members do. Conscientiously and effectively. Whilst having some fun along the way. And providing them with a sense of teamwork and accomplishment, and a boost to their confidence and self-esteem. This 4-minute YouTube video explains more about the aims, ethos and achievements of this inspirational enterprise [2]. Call Yachol competes for work on the open market – apparently very successfully. A society is measured by how it treats its weakest members [3]. Judging by Call Yachol and the international interest being shown in it, Israel measures up well. Exceptionally well. How positive and optimistic is that.
H/t Sweetheart Vivienne for alerting me to this wonderful business.

This week's compendium

Here’s this week’s compendium. This week…

1. Treehugger pointed to new data favourably comparing the yield from organic agriculture with that from non-organic agriculture [1]. The former’s bigger in a drought.

2. still talking organics, I liked an old Nutrition Diva piece titled Are Organic Foods Worth the Cost? [2]. Very sensible.

3. still talking eating, recent research confirms that a little dirt’s a good thing – because colonisation with a variety of microbes from early childhood appears important for balanced immunologic development [3]. Yep.

4. Meander Valley Radio, a community station, began broadcasting [4]. Also its home page has a link for internet streaming.

5. a US study showed best-performing nursing homes are sued only marginally less than worst-performing ones [5]. Which, interestingly, demonstrates that litigation doesn’t occur rationally.

6. I discovered bicycletutor.com which has 48 bike maintenance video tutorials [6a, 6b]. A picture’s worth…

7. I learnt what an aptronym is [7]. Did you know of this word – before now?

8. I read of how to hack any elevator to go direct to your floor without stopping [8]. Worth knowing.

Finally, I wish you, dear Farmdoc’s Blog readers, a wonderful week.

List: '60 Completely Unusable Stock Photos'

Today’s ‘List Friday’. In the top left corner of each Farmdoc’s Blog post is a photograph or image. I choose them based on appropriateness, interestingness and where possible simplicity. Some are photographs I’ve taken with my camera. But most I’ve found on the internet and used them gratis. Sometimes the best choice for a particular post is a stock photograph/image, i.e. a professionally derived one which is available for sale [1, 2]. But I shy away from them – because I’m too parsimonious, and Farmdoc’s Blog’s a mere hobby. However I can appreciate that buying a stock photograph can be much less expensive than commissioning a photographer. This said, I know nothing of the world of stock photography. I don’t know how stock photography catalogues comprise the stock photographs they do. Or in other words why certain scenes and situations are created and photographed for stock photography purposes. And so to today’s list, courtesy of Darling Meg (who has an interest in things zany). It’s ‘60 Completely Unusable Stock Photos’ [3]. The introductory blurb says it’s ‘A collection of unexplainable, bad stock photos’. Looking at the 60, I can see why. Though such is the perversity of human nature and experience, it seems hyperbolic to call them ‘completely unusable’. For I bet there are folks out there who can and do use them. Anyway they’re fun to look through. And if after doing so you crave more, look here [4].

H/t darling Meg (who wrote ‘I like number 18 the best’).

Google Body: What if?

In late 2009 I wrote I’m a physician and not a surgeon because I’m an introvert and not an extrovert [1]. In September 2010 I wrote that another reason’s I’m not fantastically dextrous [2]. But there’s a third reason: I hated studying anatomy. Actually I’ve always been, and I still am, curious about the human body’s structure. But in the early-mid 1960s when I was in the early years of my undergraduate medical course studying anatomy, it was taught in a didactic, dry and thus unappealing way. I thought so, anyway. So I learnt enough to pass the exams. But I didn’t master it. At least to the degree I needed to be a surgeon. This regret came flooding back to me this week when I read of Google Body [3, 4]. Google says it’s ‘a detailed 3D model of the human body. You can peel back anatomical layers, zoom in, and navigate to parts that interest you. Click to identify anatomy, or search for muscles, organs, bones and more’ [5]. Here’s the link [6]. In the left side-bar you choose a female or male figure. And you go from there. Left click and drag to rotate the image. Search via the box top right. For Google Body to work you’ll need a web browser that supports WebGL [7] (for 3D interactivity), e.g. Google Chrome, Mozilla Firefox, Safari 10.6 or higher. But not Internet Explorer. It’s a fantastic program. I wonder if it’d been around in the 1960s I’d be a surgeon today. I doubt it. But you never know. Ho hum.

Imprisoned journalists: a Turkish badge of dishonour

The truth. Does it exist? Sure it does. Universally irrefutable occur. For example today’s date, the value of pi [1], the 2010 AFL premiers (Go pies) [2]. In contrast, non-facts must be interpreted. For the past 200 years or more, that interpretation’s been done by the media. Specifically journalists. And whilst they haven’t done a perfect job, they’ve done okay. And clearly the more independence they’ve had, the more credible their output’s been. And vice versa. Interference by media bosses, and by governments more so, detracts from the media’s credibility. And thus utility. So then, which nation has the most imprisoned journalists? According to the International Press Institute, it’s Turkey [3]. With 57. (China and Iran tie for second, with a mere 34 each.) A surprise? Not really. For me, anyway. Traditionally a fairly liberal democracy, recently Turkey’s been islamising [4]. Because islamisation restricts freedoms, it’s no shock Turkey leads the world in jailed journalists. I hope, but I’m not optimistic, this badge of dishonour will be taken into account when the EU decides on Turkey’s membership application [5]. That application, and Turkey’s continued NATO membership [6], should weigh heavily on the minds of Turkey’s voters come the 11 June national election. I await its outcome. With interest.

Review Tuesday: 'My Afternoons with Margueritte'

Today’s ‘Review Tuesday’. My Sweetheart Vivienne won two free tickets to My Afternoons with Margueritte [1, 2, 3] – a 2010 subtitled French film starring Gerard Depardieu. We saw it last Thursday evening – at the end of my ‘4-hour delay day’ [4]. It’s the story of an improbable friendship between Depardieu’s character Germain (a 50-year-old uneducated, minimally literate and seemingly oafish builders labourer) and Margueritte (a cultured, bookish, prim 90-year-old lady). By chance the two meet on a park bench. Germain counts the pigeons, and he’s named all 19. Margueritte’s fascinated by them too. Their friendship blossoms. Each gives; and each takes. But we see him develop more. Maybe because his baseline’s lower. Though this movie’s a hybrid of My Fair Lady, Being There and Tuesdays with Maurie, it benefits from its intergenerational dimension. At its end – which comes unexpectedly without being unexpected – tears were streaming down Sweetheart Vivienne’s and my cheeks. We both felt cheated of a few more scenes – to show us what happened next. And that, I reckon, is the hallmark of a fine film. My view, as a semi-neoluddite from backwoods Tasmania, is that the current plethora of so-called social media contributes little if anything to our ability to form meaningful relationships and develop them over time. My Afternoons with Margueritte is a model relationship case-study: sensitive, languid and joyous. Though I saw it gratis, it gave me so much it would’ve been worth the admission price. It’s a wonderful film. I rate it four stars.

Let each and every bad guy know he’s never safe

Today I’ve been dry-eyed. No tears from me over the deaths of two men in Sudan last Tuesday. Their car was hit by a missile [1]. It’s unclear if the missile was an air-to-ground [2] or ground-to-ground one [3]. Arab news sources reported one of the men was a senior Hamas arms smuggler [4]. DEBKAfile said the smuggler was organizing a shipment of mustard gas and nerve gas bought by Hamas and Hizbollah, with Iran’s help, from Libyan rebels who’d looted Gaddafi’s stockpiles [5]. This account’s credible. Likely even. Whether the strike’s morally defensible, or even legal, bothers me not. Israel does what she has to do. Because for her it’s backs-to-the-wall stuff. But if it was an air-to-ground fired from an unmanned aerial vehicle [UAV], I marvel at the strike’s technology. While it describes slightly different hardware, this gizmodo article provides some insight [6] Likely the car was ‘painted’ by a laser beam – possibly from a satellite – and the UAV's missile homed in on that ‘paint’. Whether the strike was from the air or the ground, as I’ve written: He who lives by the sword, dies by the sword [7]. So let each and every bad guy know he’s never safe. Amen.

The Iranians told the Israelis: ‘You know we are cousins'

Today’s ‘Positive and Optimistic Sunday’. Indeed today’s the fifth consecutive ‘Positive and Optimistic Sunday’ post about Israel. Readers of Farmdoc’s Blog [1] and other citizens of the world, know of the deep-seated enmity between Iran and Israel. I blame it on the Iranian ruling regime’s anti-Zionism, anti-Semitism and Holocaust denial; and the incitement that results from . But whatever the enmity’s cause, no-one doubt it exists. Or does it? In the wake of the Tōhoku earthquake and tsunami that hit Japan on 11 March, Israel and Iran both sent humanitarian delegations: Israel’s comprised volunteers from ZAKA [2], and Iran’s was an official government delegation. In the city of Kamaishi [3] both teams worked side-by-side [4, 5]. The ZAKA delegation’s head said: ‘We shook hands and became friends. At one point they set up a stand and wanted to hand out food and medicine to the locals. We joined in and there we stood, side by side, handing out food and medicine. They removed the Iranian flag and removed our Israeli flag and we just stood there together. It was very odd. We were suspicious of them. We hesitated a bit because they hugged us too much’. The Iranians told the ZAKA people: ‘You know we are cousins. The wars and conflicts are between the leaders, but between the people there should be peace. We can’t forget we were close once’. I can’t explain any of this. But it makes me feel positive and optimistic. A tad so, anyway.