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Learning to be Patient

29 August 2003

Chasm, BC, Canada

Staying in hospital can be a bit like camping, minus the scenery and fresh air. People will suddenly appear next to you, and for a day or so you practice forebearance. Then you begin to either get friendly or annoyed. Perhaps both. In the impromptu intimacy of boredom, or shared discomfort, you may even find yourself blurting out precipitous confessions on matters which other neighbors, of 30 years standing back home, have never heard about. Then, as quickly as they came, they're gone. Perhaps without goodbyes. By the end of the week you struggle to remember their names.

So it goes. The social habits of campers and patients may require a special dispensation, like those of relatives.

When I arrived at University Hospital in Edmonton, I was paired with ... let's call him Gary. He's a 54 year old contractor. He had his first heart attack in September, 2002. He had another that October, and another in December. In March he was dead on the table for several minutes, while a surgeon cut open his chest and massaged his heart by hand. By April of 2003, he was living full time in hospital, waiting for a heart transplant. At some point his feet curled up and swelled, so that he had to wear corrective orthotics. He moves painfully around the ward, sometimes twice a day, pushing ahead of him, like a Mexican Penetente, a peculiar metal double cross on wheels, hung with IV bags.

There's these facts about transplants: There are none new. Every heart is used. Each has a history. All have to be matched to your blood type and size. Gary is type O, as I am. Only type O can match type O, which makes it harder to find a suitable replacement. While I was there, Gary's phone rang. He was offered a heart from Saskatoon. The previous owner died in a car wreck, but not before acquiring a case of Hepatitis C. Accepting it would probably mean an eventual liver transplant. After an agonizing hour with his family, the phone rang again. Seems the fellow also had the West Nile Virus.

At that point, Gary's doctor took the proposal off the table.

Next day, he went into CCU, to be treated for excessive fluid in his swollen legs. I got a welcome night of rest. Gary has the irritating habit of waking at 3 am and commencing to swallow air and belch loudly for an hour or more. It echoed in the room. Over and over. Many a heart symptom parades as indigestion, and vice versa.

I spent most of my time in the 5th floor library. The telemetry allowed that long a leash. University Hospital is a fine imposing facility, built around 2 huge glassed in atriums as long and high as the building. Throughout the year, patients can sit in the sunshine, which must be especially welcome when it's -30 F out and a blizzard blowing.

The weekend Edmonton papers are full of the disaster in Kelowna, BC. But someone has a macabre sense of humor. Twenty thousand people evacuated, 220 homes consumed by fire, and out of all that, who do they choose to interview? A family named Ash.

I got here on a Friday, around noon. As in hospitals the world round, nothing much in the way of progress could be made over the weekend. On Monday I took a stress test. Until then, no damage had shown up, but when Dr Choy saw the results he scheduled a heart catheterization for the next morning. I was surprised, as I had no pain or difficulty with the treadmill, and barely broke a sweat. It did seem they ended it early, at 9 1/2 minutes.

During the catheterization they found the source of my discomfort, and it was scary looking booger. For those unfamiliar to the procedure, in the first stage they release a sort of ink that outlines the interior of the artery as it passes through. The patient is awake during the whole thing, and gets to see the same computer screen the surgeon is looking at. The patient is supposed to monitor his own condition, and report pain on a scale of 1 to 10. 10 being the worst pain you've ever had. It's an interesting experience, but not one I'd recommend you undertake merely for the novelty. Have a nice day on the beach instead.

It turns out that the leading edge of my previous stent, done two years ago, had collected a pile of debris, and was almost totally closed. All that was wanting was something to come along and occlude that last 5 per cent. Goombye. By such a slender thread we hang, unknowing.

It seems Maynard was not far wrong.

The plan, as explained to me on the spot, was to place another stent inside the first, overlapping the area, and inflate it. No problemas.

Well, a few. First the computer crashed. I started to ask if they were using Windows, but the moment didn't seem right. Surgeon and assistant stood around with gloved hands in the air for 10 minutes while some dulcet toned geek in the back room rebooted.

"Stop. Doctor, we will not have double plane."

A moment. "That's okay. Single plane will do. We are already at the site." He turned to an assistant behind me. I think he said, "Administer 1cc Heparin per kilo."

A woman's voice: "Er, Doctor, he gave his weight as 250 pounds. How do I make that conversion?"

O God. I'm in Canada. I started doing the math. Visions of the last mars mission flashed through my head, when some very smart people forgot to convert inches to meters. Thunk. No thank you.

They all talked it over, and came to a consensus weight in kilos that was close to what I came up with. I never said a word. Perhaps I groaned a little.

Computer up. Blood thinner administered. The Pain started. Let me explain. The surgeon has inserted a thin flexible cable perhaps 3 feet long in my groin, and worked it up through smaller and smaller arteries to the blockage in my heart. His job now is to place a tiny collapsed springlike metal coil attached to the end of that cable precisely into the gap left by the clot, and expand it with a small balloon until the clot is crushed between spring and artery wall.

This takes time, and while it is going on, NO BLOOD IS BEING DELIVERED TO THAT AREA OF MY HEART. It burns like the devil.

If it goes on too long, the deprived heart muscle dies, and those little cells do not go quietly into that good night. They rage and scream at you: "HEY, BOZO! YEAH, YOU! IF WE DIE, YOU DIE! DO SOMETHING, IDIOT!!! DO IT QUICK! DO IT NOW!"

That's right, dear friends, they are giving me a heart attack, right there on the table, and I'm not supposed to bother the surgeon by thrashing about and moaning. He is trying to manipulate something tiny at the end of a bit of fishing line. Doesn't pay to distract the fisherman at this juncture.

It did not go well. The surgeon asked his colleague standing by to help. Apparently this is a teaching hospital. I lay there puffing, listening while they discussed the problem in polite measured tones.

"I tried approaching from above. It won't go through."

"No, you have to come from below, like this, then let it turn up..."

Various things were tried, but no go. The lip of that old stent was just caked with stuff. Finally they backed off a bit, and let some blood through. Immediate relief. Then they talked about using a different stent, apparently stiffer or harder, that wouldn't double up on them when it met resistance.

Lots of activity at my deadened groin, removing, reinserting.

"Now Mumble Mumble at Winnipeg has been using these for years with good results, but there's always the danger.... I don't usually like to .....blah, blah, blah." They are discussing me as though I'm not there. I know that similar calm discussions probably go on during any surgical procedure, and perhaps at times ought to, but the patient is usually out and not privy to it.

I want the guy calm. Truly. I am enjoying the lecture, but could he GET ON WITH IT?

I managed to croak out in a somewhat controlled voice: "Doc, I think you should know I'm in a lot of pain, maybe 8 or 9. I feel like I'm dying here." He assured me I was not dying. He ordered more Sentinel, then changed that to morphine. It would take only a little longer.

It still hurt like hell, but with a somewhat duller edge to it. Hell lite.

Finally they got the thing in place, and started the first of three inflations. Each one was a heart attack worse than the one that brought me here. Worse than any I've had to date.

Dr. Choy showed up when it was over. He turned the screen so I could see better, and showed me a short movie of the procedure and result. A big round artery. From 5 percent open to 100 percent. Good.

When I got back to my room they took some blood. Next morning the good doctor told me that tests showed I'd suffered a little heart damage on the table, but nothing to worry about. I'm to be sure and have another stress test in a couple of months.

That very day, Wednesday the 27th, I was released. No one asked for my poor wilted credit card, though they did take insurance information. I caught a cab to Greyhound, took a 5 hour ride by bus to Jasper ($51). It was a lot more comfortable than the ambulance. I checked in at the hospital, where I had left my key, and found my truck and trailer had been safely towed to the police barracks nearby. There was no official charge for that, and it probably kept everything I had from being stolen while out at the campground. I left a hundred dollar donation for the local Crisis Team volunteers, the ones who actually did the moving.

They had been playing my Red Hot Chili Peppers album, By The Way, at volume. A little traveling music. After my hearing came back, I found a Korean restaurant and ate a bunch of things I can't pronounce. Both by way of supper, and of celebration.

Jasper seems a particularly fine place to be this evening.


It is now 7 am on a Friday morning. Perhaps 48 hours ago I was sitting in a hospital in Edmonton, a wound in my groin, a needle in my arm, and apprehension in my heart.

Today I am in British Columbia, at a place called Painted Chasm. I am alone here. It is 34 degrees. When I walked out into the cold this morning, a cup of coffee in my hand, the sun was just rising.

I sat on the cliff for a while, watching shadows melt away. Gray clumps of needleleaves on pine and spruce turned gradually green, then brown and golden at the tips. Even rocks seemed to swell in the sun.

It is so quiet here. I can hear grass whisper when the wind bends it. I can hear the pop and snap of vertebra as my neck turns, and equally the high chitter and soft flap of hidden birds above. I can hear myself thinking.

I can see my breath, a soft fog curling out into sunlight. Proof that I am alive, on a day when I need no proof.


My thanks to Dr. Choy, and to Maricel, Brian, and all the team at 5G4, who conspired to keep me alive, that I might have mornings like this.

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