My husband’s heart Part 2: Auckland City Hospital

Following on from my previous post: Brian spent 18 days in the cardiology unit of North Shore Hospital. On 23 September came the long-awaited news that a place for him was available at Auckland City Hospital. Accompanied by a nurse carrying a defibrillator, he was transferred by ambulance across the Harbour Bridge, and admitted to the cardiothoracic surgery ward in preparation for a five hour procedure to bypass his left coronary artery, replace his aortic valve, and repair the aneurysm of his ascending aorta.

We kissed farewell as he was wheeled through the doors of the operating theatre next day, and then for the first time since it all began I broke down in tears. Fortunately a close friend was available to take me out for coffee and listen to the story of our recent woes.

When the surgeon phoned me that afternoon to say that the procedure had gone well my relief was enormous. But when I arrived to visit Brian in the intensive care unit later on, I was told that he had had a stormy few hours. A group of doctors and nurses were gathered round his bedside. He was deeply unconscious and blood was flowing out through the drains in his chest.

Despite repeated transfusions of blood and blood products, his condition did not improve and shortly before midnight the decision was made to recall the surgical team and take him back to theatre. I was trembling with fear and distress, and very thankful that family members had come in to sit with me and then drive me home.

After the second operation, which involved the removal of blood clots and fluids, Brian began to get better. By next morning his vital signs were stable, and I was present to watch him being awakened from his drug-induced coma.

Two days later he was moved out of the intensive care unit into a four-bedded ward, where he stayed for over a week. On some days he made rapid progress, and on some days his condition caused concern. On two occasions he went back into rapid atrial fibrillation and required intravenous amiodarone to restore sinus rhythm. At other times his heart rate became too slow, and a week after the first surgery he had a pacemaker fitted. He had some brief spells of anger and despair, but overall remained remarkably positive.

Brian in Wd 42 after heart op.jpg

 

For myself, the physical and emotional demands have felt almost overwhelming, and I developed several apparently unrelated medical problems during the month that Brian was in hospital. These included an episode of hypertension and tachycardia beginning on the same night that, unknown to me, Brian’s recurrent arrhythmia was causing great concern. Anxiety and exhaustion were the obvious triggers for my own symptoms and, despite having done so much clinical and research work in the field of mind-body medicine, this was my first significant personal experience of stress-related illness. If I had had such an experience before my retirement I think I would have been a better doctor.

Brian has now been discharged from hospital, and although life may not be easy during the projected recovery period of three months, we are both happy and relieved that he is home again. Through this whole saga I have been tremendously grateful for the skill and kindness of the hospital staff; the marvels of modern medicine and surgery; the practical support, good wishes and prayers of family and friends; and the comforting presence of our three cats.

My husband’s heart Part 1: North Shore Hospital

It is over thirty years since my husband Brian started feeling breathless after walking up long flights of stairs. He was found to have aortic stenosis and an aneurysm of the ascending aorta. As time went by, occasional repeat investigations showed this pathology gradually getting worse, and several specialists advised cardiac surgery to prevent the risks – including sudden death – associated with his condition. He declined, on the grounds that his symptoms were not too severe and that the operation itself could be fatal or cause some intellectual impairment. His diagnosis was one factor in our joint decision to leave our medical careers in the UK and go to live in Auckland, New Zealand, where Brian had been born and brought up. That was fifteen years ago and over most of this time Brian has continued in good shape – even walking the Milford Track.

on milford track

He continued adamant that he did not want surgery. He asked me and our family doctor not to send him to hospital if the aneurysm burst, but to give him morphine and let him die at home.

In July this year, soon after his 82nd birthday, Brian had a bad attack of flu and we attributed his continued lethargy and reduced exercise tolerance to the aftermath of that. He did seem to be getting better. Then on 4th September, on the way back from an enjoyable evening at the ballet, he said he did not feel well. He refused to let me call for help. Somehow I managed to support him on the walk home, but as soon as I opened our front door he collapsed in the hall. At that point I went against his wishes and rang 111. Time will tell whether I did the right thing.

A skilled ambulance crew arrived promptly, and did an ECG which showed atrial fibrillation with a pulse rate of 160-170 per minute. They started intravenous amiodarone and advised that Brian was likely to die unless he went to hospital. With a little persuasion he agreed to go. After many hours of investigation and treatment in the resuscitation unit of North Shore Hospital he was admitted to a ward and at 4 a.m. I took a taxi home.

The immediate cause of the collapse was not a ruptured aortic aneurysm, but a 70% blockage of the main stem of the left coronary artery. With excellent medical treatment and nursing care, Brian’s condition improved greatly over the next few days, but he was presented with a stark choice – go back home with probably just a few months to live, or undergo surgery which carried a 20% operative mortality but if successful could give him many more years of good quality life. Brian decided to “cooperate with the inevitable” and accept the operation that he had been refusing for so long.

He stayed three weeks attached to monitors in the cardiology centre, not allowed to leave the ward although he was feeling fairly well. Every day we anxiously awaited the news that a place had become available on the surgical unit at Auckland Hospital. On several occasions the proposed transfer nearly happened but was then cancelled – later we would come to understand all too clearly the reasons for this. Brian appeared to benefit from the long rest, and remained in good spirits. He spent much of his time exercising in the corridor, or with his laptop computer composing a self-written obituary for Munk’s Roll.

There is much more to the story, but to avoid making this post too long I will continue next time. Please sign up in the box if you would like to receive future episodes by email. I should add that I am publishing this with Brian’s full knowledge and consent.