Take my breath away.

Wouldn’t you just know it? Just when our hero is sitting in the ICU and bellying-up to some cold mushroom, onion and sausage pizza…that’s when it happens. That’s always the point in our story when things go terribly awry. The cute girl gets killed, the CSI agent realizes he arrested the wrong person, the Cardiologist’s patient unexpectantly begins to crash. I was smug sitting upright in my ICU bed, G-52, basking in the fact that none of the nurses in their careers had ever seen a patient ordering take out. Sure, I had my humiliating hospital gown on but I was down to six electrodes, one IV line in my right arm and one drainage tube coming out of the bottom left rib cage.

There were three doctors there. Dr. Solow* from India, Dr. Evans* from Ireland and Dr. Rodriquez* from Chile. Each had their respective accents and set the stage nicely. They consulted, disagreed with one-another and debated with me, their patient, just looking for some reassurance and leadership. They finally agreed on all the variables and got started.

The procedure sucked. How’s that for eloquence? Even while taking one Xanax, IV Morphine, IV Demerol and two Percoset…I kid you not. I had all this and then I had three injections of Lanacaine at the site of the insertion applied at three different levels under my left pectoral between my ribs. The next 30 minutes were the most painful I had since they pulled out the chest tube a couple of days earlier. But when they were done I slowly started feeling better and marveled as I watched almost a liter of milky blood-like fluid removed from my chest. I’ll never look at penne with pink vodka sauce the same way again. The tube was draining into what looked like one of those old fashioned IV bottles that Dr. Frankenstein likely used. It was all glass, clear and shaped up to the top where the tube was inserted into a quarter size top with a soft membrane covering the top. The bottle had a vacuum affect drawing out the fluid first spraying and then eventually slowing to a drip and then stopping. When that was done, twenty minutes later, they removed the bottle and replaced it with the labyrinth of tubes, fat syringes and this grenade shaped plastic bulb that had all of the air squeezed out of it. The fluid now had a lot of places they could go and the doctors set-up various switching of the “train tracks” so that when more fluid built up, it would automatically come out into either the syringe or the grenade. I didn’t care, the pain was gone. They left in the catheter/garden hose that was meant to continue draining the fluid over night. This was it! They’ll pull the tube out tomorrow AM after a clean Echo and let me go on my merry way. This calls for pizza! My parents had come in from the waiting area and were relieved to see that I was in good spirits. They stuck around until the pizza got there and then went to get a bite for their selves around 8:15pm. They’d be back in an hour but had no idea what they would witness upon their return.

I ate three slices, which is more food than I’ve managed to eat all week. I had no appetite until now. I was watching baseball even though the Yanks made an early exit, and now, all the drugs were making little fire-flies dart around my field of vision. And so, the next 45 minutes were wonderful in the “I am truly over the worst of this now” find of way. Man, was I ever wrong.

[Deep breathing exercise to expand lungs. Thanks for your patience.]

It was quiet in this ICU tonight. When I first came down into recovery after the surgery it was chaotic. 11 patients, the max, with various connections to man-made contraptions meant to thwart Darwinism. Beeps, buzzers and tones constantly going off in a cacophony of chaos mixed with the wails of the infirmed and the disturbingly disinterested guffaws of the ICU staff made for the perfect healing environment. But tonight was different. There were only 6 patients which meant less beeps, wails and nurses guffawing. The nurses were actually empathetic, sweet and focused primarily on their patient. One nurse per patient. Tonight mine was Sarah, a 24 year old RN whose father had worked at the Cleveland Clinic as a nurse for 20 years, was looking after me. She was tall and thin and had a black bob with streaks of red in the front. She was shy but competent and you would think that this is the norm at all medical institutions, but what I came to realize during my week here in Cleveland is that there is incompetence at all levels, but I’ll save this for another entry. Let’s focus on the topic dujor. Scary shit.

When we last left our hero he was appearing in the DVD release of Fantasia, feeling happy and looking forward to going home soon. It was 9:00PM and he was lounging in his polka dot gown and plying the nurses with left over pizza. All was well. Through the main ICU doors came in Ben a tall kind RN who I had met and spoken with a few times both in the ICU as well as the heart center floor. I trusted and liked Ben. With him was Dr. Sidow*. Dr. Sidow was apparently the head of something. I never met her before, she didn’t introduce herself or directly address me. I might as well have been the coffee machine in the cafeteria. This happens a lot at “teaching” hospitals. In any given day I would be “observed” by 8 different cardiologists or surgeons who were at various levels in their career, some I would only see once and only once. And I have gathered one of the unwritten parts of this game is to agree with the “right” doctors and disagree with the “wrong” ones. Make your name but be careful how you do it. So Ben wanted to show Dr. Sidow how the procedure went. Ben folds back my blanket and she focuses on chest. She looks for barely a moment and declares to no-one in particular, “Why did they do it like this? They left it in the wrong position!” Now who am I to disagree with her? I’m not a medical professional and she IS a Dr. and to be fair since the three doctors left, no other fluid drained. So she turned a couple of the train switching valves and pulled on the syringe and in the process sucked extracted another 50CCs of fluid. She made a couple of more changes with more fluid slowly dripping into the grenade. And with this I started feeling some slight pressure in my sternum. “There we are, now that’s the way it should be, there needs to be constant suction.” And with that she and Ben walked away as quickly as they arrived. But the pressure was increasing unnervingly quickly. She and Ben were at the ICU exit about 20 yards away and I yelled, “Dr.! Ben!” But my breadth was be drained along with the fluid and I barely got out my cry for help. They turned and left at which point Sarah popped her head in. “How ya doing, sweetie?” “Um, I’m not sure. This doctor and Ben came over pulled some fluid out and now I feel like I have a tremendous amount of pressure on the center of my chest. “OK, I can give you more some more Demerol and then I will go find Ben.” Sarah quickly administered the additional drugs and they did nothing. Sarah was off to find Ben and the Dr. and this is precisely when my parents walked in.

I watched the blood drain from their faces as they walked up. There I was lying on the bed with a bunch of bloody tubes and contraptions coming out of my rib cage. I’m gasping for air and lying flat on my dripping with sweat. “What’s happening!” asked my mom.” (In between gasps) “T H E Y A R E L O O K I N G F O R T H E D O C T O R.” At this point Sarah gets back and says she found Ben but not the doctor. “Ben said it is normal to feel some pressure and than I can give you some Morphine.” And she does, dropping 25ccs of morphine into my IV on top of everything else floating around my system. (In between more exaggerated gasps “SARAH, I NEED A DOCTOR, IT’S GETTING WORSE!” “We need to get a doctor here right away!” My Mother says. “OK, I’m paging the staff cardiologist who is on duty” exclaims Sarah. At the Clinic they use a pain scale to determine how uncomfortable you are. You are asked constantly, “On a scale of 1-10, with 1 being the no pain and 10 being unbearable, how would you rate your pain?” In a mere 15 minutes I went from a 3 to a 9. When my parents left me an hour ago I was laughing and eating pizza. Now they are watching me splayed on my bed, writhing and unable to speak. My head is whipping from left to right and back again. Sweat is flying off my brow across the room and I feel as if I am being suspended in mid air with a Neanderthal spear driven right through the center of my chest and out my back. Imagine the movie Alien and just prior to the juvenile alien hatching from their human hosts. This is the only other way I can explain the pain. My parents are now looking left and right for help and Sarah reappears and announces that Dr. Moula is on her way down from Cardiology. And now some of the other nurses are gathering around but not doing anything in particular. I don’t think they knew what else to do. It was like slowing down to watch an in process car accident.

Dr. Moula burst on to the scene through the doors and she was pushing an Echocardiogram machine. Dr. Moula was a thick woman with some sort of Eastern European accent. After she quickly introduced herself she sat down on the bed next to me and focused on nothing but me and Sarah. “What do you feel?” She asked with focused determination. I managed to blurt out where the pain was. My father looked pale and had his forehead in his hand…which is the same thing I do when overly stressed. They were helpless, watching their second son and if they were like me at this point, they actually started to wonder whether or not I was going to make it. But at moments like this, you cannot allow those thoughts to embed themselves. You need to focus with the doctor. Dr. Moula worked the echo around me chest and told me everything she was going to do before she did it. She firmly requested tools from Sarah who remained remarkably calm. “There’s your mitral valve, it looks good. Your left and right atriums look ok. Stay focused, Mr. Salvati, I’m going to take care of you.” And, I believed her. “Ahh, I see! The catheter, it is rubbing against two sections of the heart. This syringe shouldn’t have been left on drain…otherwise this happens. Sarah, page the Cardiologist who performed this, I want to get permission to pull this out. It doesn’t need to be in there!” “P U L L I T O U T!!!” I yelled. “OK, I’m going to pull it out a little to see if that reduces the pain.” And she did, and it didn’t. “Sarah, get me a double saline syringe wash!” She attached the double syringe and told me she is adding fluid to relieve some of the irritation. At this point the pain shot up throughout my right shoulder and arm. “OH, MY SHOULDER!” “That’s it,” she said firmly, I am not waiting for permission! OK, Mr. Salvati, I am going to pull this out and you are going to feel better.” Dr. Moula then started pulling out the tube which seemed to go on forever. Earlier, the cardiologist who was performing the procedure told me that the heart is about 3.5 inches from where we are entering. I can handle that, I thought to myself. Well, Dr.Moula was still pulling like a clown pulling out tied scarves from magic hat. In total the catheter was more than 3 FEET inside my chest. Why? I don’t know.” “There, how do you feel?” “I don’t know.” I huffed. And then I heaved and tried to gasp and then it happened. The pressure and pain started to slowly ease. “I think it is getting better.” I said. “You’re going to be OK. They shouldn’t have left this in. There isn’t any more fluid to drain and when that happens the heart walls start rubbing against each other with the catheter in the middle. The heart gets irritated and it starts looking for more fluid to drain.” And now, just five minutes after the 3 feet of garden hose is removed from my chest, I’m feeling better again. “I’m a 3 now.” “OK, Mr. Salvati, if you need anything else just page me, OK?” “Will I have to do this again?” “No, you shouldn’t have to. Just get some rest and you’ll be fine in the morning.” And with that Dr. Moula left with little fanfare. I thanked her profusely as she left and after my parents were sure I was better, they too left for the hotel for a relieved but likely broken sleep.

I sat on the edge of my bed leaning over the tray table, still sweating but breathing better and feeling less pain. For a few minutes I sat and didn’t move, just happy to be there.

And now, it is the following evening and I am sitting in my parent’s hotel room. I made it out. I have another echocardiogram tomorrow afternoon, and if we get through that we are on our way. I have no electrodes, needles or tubes in me right now, and I want to keep it that way. The appointment is scheduled for 3:40 Friday afternoon. Please send good thoughts then if you remember cause it’s time to go home.

* These names have been changed.

~Joe

8 days post-op