2013 17th Sep: CABG

This is an account of my Coronary Artery Bypass Graft (or CABG), a massive (and expensive) operation at Southampton General Hospital. If they offer you one, think very long and hard before accepting.

Nature's Gift of Pain

To look ahead to the actual operation I expected to wake up in a sea of pain but was pleasantly surprised. Apart from when I coughed and from aches and stiffness in my back and arms, I was devoid of anything I could describe as pain. This seems to me a cause for extraordinary congratulation of the surgical staff, in that they can cut you wide open, stitch you up again, and leave you smiling. (I have since realised that your chest and its innards probably have far fewer nerve cells than e.g. your shin, an area which eventually caused me untold pain).

However the lasting impression I have of the total procedure is one of pure misery. I apologise for the length of this blog but the devil is in the detail. I never took any pain-killers the whole time I was in hospital, although for reasons that escape me the nurses several times tried to bully me into taking them. Pain is nature's gift for warning us. Don't ignore it. Now, three weeks after the operation, and as I start to write this blog I'm in considerable agony from the wound in my 'donor' leg (where they took the spare tube from). I'm now sinking paracetamols as if they were jelly babies.

Heart Attack

Friday 16th Aug

I started feeling mildly ill in the afternoon. As it happened I had a 7.30-10.30 gig at a french-styled restaurant in Portsmouth. I dropped my piano keyboard off at 6.00pm and then walked round to a nearby indian restaurant. I knew I was walking slowly and I had angina pains in my chest, but that didn't stop me enjoying a couple of pappadoms and a Madras chicken curry.

However I was in trouble as I walked the 200 yards back to the venue. It's dead flat but I had to stop and sit down no less than three times. The bass player was already there and I said

"I feel awful."

I sat down for ten minutes but then put my keyboard together and played the evening through. In the spirit of 'the show must go on' I shall now claim I played a gig while having a heart attack, though it was clearly a very small one. I needed help reloading my car afterwards but I drove home to Southampton and slept well enough although I had a permanent angina ache across my chest which wouldn't go away after using the nitro-lingual spray that usually corrects the problem.

Saturday 17th Aug

Next morning I still had the ache and I stayed in all day not doing anything energetic. But when I went to bed I couldn't sleep through breathlessness. It was like being at mile-high Denver, say. Every 30 seconds I nodded off, only to wake immediately, gasping for breath. In Denver I would have adapted to the situation in less than an hour but in this case the waking up continued all night. In desperation I got up at 4am, put the light on and looked up "shortness of breath angina" on the computer.

The article I found was spot on at describing my symptoms including coughing up phlegm from my lungs, which I probably would not have associated with the situation. It advocated using extra pillows under one's head or back, the argument being that you want your blood to run to your lower body. It worked like magic and I fell asleep immediately, waking around 6.30 am.

The article was also full of doom and gloom, threatening imminent heart failure and advocating an immediate 999 call. That sort of thing works on your nerves and since I still had the continuous chest pain and didn't fancy another night like the last, I decided to drive into Southampton General A&E, getting there at 7.00am Sunday morning through deserted streets.

Sunday 18th Aug

I must say they make you feel like royalty if you mention chest pains. An immediate blood test and ECG revealed that my heart had some damage (it's clever that they can find this just from your blood) which had almost certainly occurred on Friday afternoon. I was impounded in the Coronary Care Ward with a promise that they would give me an angiogram the following day.

Despite the initial rapidity, all this took till 11.30, with repeated descriptions by me, multiple blood tests, multiple ECGs, a chest Xray and more.

Diagnosis

Monday 19th Aug

The following day I was expected to have an angiogram, where they pass a wire up through your wrist all the way to your heart and thereby monitor how badly your arteries are furred up. So I was 'nil by mouth' from midnight Sunday. Time passed, and around 3 pm Monday afternoon they came round and told me I'd been cancelled. I took a grateful drink of water. The problem was the first patient had been complicated, and then a couple of emergencies came in to jump the queue.

Tuesday 20th Aug

I was 'nil by mouth' again, but this time I was the first to go in.

They lay you flat on your back on a very narrow, hard (why?), table so that after 40 minutes I was dying for a wriggle, but you're supposed to lie still. They give you a local anasthetic in your wrist and then push a wire up your artery. After a couple of minutes I felt something in my upper arm and I said:

"Have you got to my shoulder, now?"

"No, we're already at your heart."

When they take photos they ask you to breathe in, which explains why they need you conscious. After 45 minutes the unseen doctor appeared and announced that I had two occlusions and a section of furred artery. Stents would not do the job and I would need to have bypass surgery.

This was a dreadful shock to me. I had managed to convince myself that by sticking in a couple of stents they would restore my circulation and I would be right as rain. After all, I have never been a 'serious' angina case, and only the prevous week I had climbed the Briksdal glacier in Norway (height rise 520 feet). So how had I gone from hero to zero so quickly?

But there was no arguing and they said they would book me in for the bypass 'as soon as possible' i.e. without my going home.

Back in the ward I was in a foul temper and I began the process of ringing all my friends and relations with the news that I would be out of circulation for a good while. The bypass is not a pretty operation, and two other men in the ward were already recovering from it. They cut your sternum (breastbone) straight down the middle, and then pull your ribs apart. They disconnect your heart, giving the job temporarily to a machine. Then they cut veins out of your legs and use the tissue to bypass the dodgy heart arteries stitching the joins with sutures that stay in for ever. Then they sew your breastbone back together with wire, which also stays forever. They also put a 'plug' in the side of your neck to control the anaesthetic. You are unconscious for about 8 hours so they fit you with a catheter. The expected recovery period is about three months.

Sometime after lunch it occurred to me that maybe I didn't have to do what they told me. I was now perfectly chirpy with no angina symptoms. Why didn't I just walk out of the hospital and survive for however long I might expect? The previous April I had been diagnosed with prostate cancer and I'd never really believed the oncology doctor, Mr Harris's, assurance that it would not kill me and that I would die first of a natural death (although I seemed to be doing my best to make that forecast come true.) If I only had a year to live then did it make any sense to spend three months of it recovering from a horrendous operation?

One point of writing this blog is to advocate that everyone should think long and seriously before being railroaded into an operation. Everyone in the hospital just goes ahead with the process that's almost 'preordained' by the circumstances. You WILL have the operation because it could save your life.

Having decided I was really going to consider opting out I needed to check on a couple of important things:

  • Why did I no longer have angina pains? I managed to bag a Doctor Martin and drag her off to a separate office for a discussion. I explained my dilemma to her and predictably she told me I'd be better off with the bypass. When I was admitted they gave me clopidogrel which is a very powerful blood thinner (so powerful that they have to discontinue it and then wait 3 or 4 days before they can do any operation). It wasn't recommended as a permanent long-term cure for angina. (I've since looked it up on Wikipedia and it says "Adverse effects include hemorrhage, severe neutropenia, and thrombotic thrombocytopenic purpura (TTP)", whatever that is).

  • Everyone else in the ward said that I would feel much better after having the op because my symptoms would be gone forever. One man had his 20 years ago, the scar was practically invisible, and he said it was new lease of life. His wife said once its success had been OKed you would get better travel insurance. This was all very positive but to me it sounded a bit like a group of previously press-ganged sailors heartily welcoming a new arrival just dragged in from the docks.

  • How long did I really have to live from cancer? I rang Mr. Harris's secretary and asked whether I could speak to Mr. Harris urgently, or to Gus, the oncology nurse. She promised to try and fix it.

    Wednesday 21st Aug

    Gus came over to see me and was about as unconvincing as Dr. Martin. He assured me I was good for a few years yet. We had a discussion about the financial merits of giving expensive operations to patients who looked pretty near the end of their innings. But he just said they had a 'duty of care' to everyone. I don't think that's right (see later).

    Some time that day I had an idea so brilliant I wonder why none of the doctors thought of it. It occurred to me that I was to have a blood test (for Potassium, actually) and I simply asked if I could tick the PSA (Prostate-Specific Antigen) box in the list of tests the technicians do. The nurse couldn't OK it but a nice young doctor was called, I explained the situation to him, and duly got my PSA measured.

    Thursday 22nd Aug

    After lunch I went to the nurses' desk and asked if I could see my last PSA reading. She looked it up and said:

    "5.4, normal."

    "No, that's wrong ," I said. "It can't be."

    But she insisted and I wandered off, unconvinced. The previous readings had been 88 and 130, both very high and certain pointers to prostate cancer. But I got to thinking about it. They don't usually make mistakes. Maybe it REALLY was that low.

    Friday 23rd Aug

    I phoned Dr. Harris's secretary again, told her the reading, and asked if I could speak to Gus again. He came over mid-morning and said the reading was quite plausible, given that I'd had female hormone treatment in the meantime. During the subsequent discussion for the first time I began to believe what they said about the effects of cancer. If you ask anyone to name a 'terminal' disease they will probably come back with 'cancer'. But to be pedantic you don't die of cancer only from the withdrawal of service effects it may have on the organs it attacks, e.g. liver or bowel. Since I don't need my prostate any more, there's no reason why the cancer should impact me. Of course this argument breaks down when the cancer metastases to the bones, because you do need your bone marrow. And also, I understand that the female hormone treatmeant only works for a limited time.

    So at last I agreed to the bypass formally, for the first time. This lead to them giving me a breathing test, a bit like the breathalyser. You have to expel from full lungs as hard as you can. I passed, though it left me in a flurry of coughing afterwards.

    Around midday they told me I would have to move from the 'recovery ward' where I was to a new pre-op ward, lo and behold to my own room. The new room was marvellous, although it seemed that getting cups of tea was going to be much more hit and miss. But there are no more beeps and bumps in the night, just blissful silence. (I can even close my door). The only downside was that the nurses had a radio tuned to Wave105 which bleated out guff all day long (though I occasionally crept out and turned it down).

    Saturday 24th Aug

    Among other visitors was the bass player from the fateful gig and he had brought me a lump of 'Old Amsterdam' Gouda cheese from Waitrose. This is a far cry from the normal visitor's grapes and chocolate offering but it was a godsend. It has such a brutally strong taste that even a tiny lump can suppress the after-taste of the medicines they were filling me with.

    Urine

    Right at the beginning the doctors who examined me seemed very excited about my ankles. I agreed they were 'puffy' but they've been like that for years. The thing is they didn't like my chest which certainly had some fluid in it, so they prescribed furosamide (via cannula injection) to lower my fluid retention (i.e. to make me pee). I mention this because the whole thing quickly spirals out of control. First of all they want to know how well it's working so they require your urine to be weighed, inconvenient for me and obnoxious for the nurses that have to weigh it.

    I got the first injection of furosamide about midday on Sunday (my day of admission) and in the next 24 hours I counted no less than 20 urine bottles that I gave to the nurse. But it certainly worked. I was 109.9 kg when I came in. I lost a Kg every day until it got down to 106.6 and then it flattened out.

    This struck me initially as something of a joke but it certainly wasn't. Because of the furosamide they gave me regular blood tests and on about the third day the nurse informed me that my Potassium level had got dangerously low. (Potassium is critical for nerve functions.) So I was to have a drug called Sando-K to boost my Potassium. In the ward we referred to these as 'horse' pills because they are so huge. They fizz up in water and have a violently unpleasant salty taste.

    So here we were with a typical escalating sequence of events. It's as if the doctors attack your body with glee, giving you first one drug, then another to counter-effect the first. But the human body is a very complex adaptive mechanism and it tries to compensate for anything you do to it. This urine fiasco I blame for my relatively slow recovery after the op, as I was clearly short of vital salts.

    I understand that reducing the body's fluid means the heart has less work to do but I cannot see why this has to be so violent. A smaller dose that left me in more normal balance would have been better. And now, three weeks after the op, my arms are still covered with hit marks from all the blood tests.

    Sunday 25th Aug

    In the afternoon (round about 12.30) the nurse showed me a 'day lounge', not that far away from my ward. It's a lovely room with comfortabe chairs and a huge TV set on the wall (which is magically turned on and off and the channels selected via a single control). I wanted to watch the Belgian Grand Prix and I sat in splendid isolation as they toiled through the pre-race woffle. Then exactly as the race started a patient with badly swollen eyes came in accompanied by his 3 or 4 visitors. Their prattle was absolutely deafening and they stayed right up to the end of the race before leaving so I couldn't really hear the commentary. Shame. I have no way of knowing what's on or I'd go to the lounge again.

    Monday 26th Aug

    An amusing thing happened this morning (there aren't many). My room has double doors and I normally leave only one open. When I need to pee I stand over in the corner behind the half-open door. I was doing that when Debbie, the nurse came by, looked through the door, and said

    "My God, he's vanished!"

    I could hear the panic and disbelief in her voice because she'd been outside all night and it seemed like a conjuring trick.

    I put her out of her misery, but I wonder what would have happened if I'd let her alert security to a missing patient.

    Today was the August bank holiday. When someone mentioned that last Thursday I swore roundly because obviously there are no ops today. It effectively put my date back more than a day because there will still be emergency cases coming in to build up a log-jam. I begged the doctor to let me go home for the week-end (a full 5 days). But he was having none of it. He said I was in danger of another attack. I said I'd willingly indemnify the hospital. Then he said that if I went home I would 'lose my place in the queue'. That's obviously pure blackmail - they can organise the queue however they see fit. It's also very bad economics. It must cost say 500 pounds per day to keep me here. So they are wasting 2500 pounds for nothing. If I went home and kicked the bucket they'd be even better off.

    Shock. That evening a new doctor came in and said they could operate on me the following morning (I had expected another couple of days). He asked me a few questions, did a few tests, and decided I was up for it. I signed the release form. I did this in full knowledge, having spent a lot of soul-searching in the previous week. Given my time over I might well change my answer.

    The Operation

    Tuesday 27th Aug

    This day disappeared from my radar. I remember being woken up, having most of my body hair shaved off, and being adorned in a hospital 'ball-gown'. But I don't remember being wheeled anywhere, nor being given any anaesthetic. I must have woken up some time Tuesday night, but Wednesday was my first 'conscious' day.

    Wednesday 28th Aug

    As mentioned at the top, I can't say I was in any pain. However, the clutter they lumber you with is really quite awful. I had an object about the size and weight of a house brick attached to me by wires and I was terrified that if I inadvertently kicked it out of bed it would fall, tearing my innards out. It was my own personal ECG. I had three 'drains', tubes that removed blood and muck from my stomach, a catheter feeding urine somewhere I never fully grasped, and various other tubes, too vague to understand. (Fortunately your body reacts to all this medical violence by temporary constipation, which is a merciful plus.)

    I couldn't see the scar on my chest though I later found it to be a surgeon's work of art (as indeed were the drains, even though I complain about them). The trouble was that the 'donor' leg, my left leg where they removed the vein was covered in fearsome bruising (it still is today, three weeks later) and the scar that ran literally from my groin all the way down almost to my shin, looked as though it had been created with a rusty Stanley knife. Much more about this later.

    Sometime Wednesday afternoon they got me to stand up. That did not sound like such a big deal but with two nurses holding me up my legs were pure rubber. I don't really understand that - how an anaesthetic can reduce you to jelly.

    Nor do I understand how I got through the first couple of nights., With all that clutter attached you really can't turn over - all you can do is call a nurse when you need to move.

    They took two of the drains out on this 'first' day and that was the only really painful experience of my stay. They gave me a mask with some sort of gas that they use to help women in labour. All I can say is that for me it had no discernable effect whatsoever, but with two strong male nurses holding me down they were able to remove the drains despite my howls.

    "That's as bad as it gets," one of them said, and I'm glad he wasn't lying.

    I learned that apart from the triple bypass they had also replaced the aortic valve. An 'echo' test subsequently proved this was working as designed. The test technician asked me if I had a plastic or tissue valve. I didn't know but I later learned that a tissue valve means tissue from pigs. These work fine (and I have one) but tend to give out after 30 years. So if you're younger than 70 they give you a plastic valve. The downside of that is that you have to take Warfarin (rat poison) for the rest of your life.

    Thursday 29th Aug

    I was moved from "Hi Care" to a recovery ward, although still with most of the clutter attached. One of the nurses there, John, was almost inspirational in his approach to new patients, making them as comfortable as it was possible to be and promising that things would get better.

    A very strange thing happened on Thursday evening which I can't understand. I suddenly felt very unhappy in the bladder region. If I stood up I was OK, but when I sat down I was overcome by a violent urge to pee which I seemed unable to satisfy. The nurse assured me the catheter was working but that was no relief. I burst out in a dreadful sweat with perspiration pouring down my back. Eventually the spasm passed, thank goodness.

    In the middle of that night, as far as I can remember, a nurse came round and deftly removed my catheter (I think she actually did it in the dark). I began to brighten up.

    Friday 30th Aug

    They removed the rest of my clutter, including the ten-ton ECG machine, and I was free to move about again. As seemed to happen to most people I had one disaster which I couldn't understand. I went to the toilet, looked round, and found I was wearing soaking wet pyjamas and there was pee all over the floor. Out in the corridor I tapped a nurse on the shoulder and said:

    "I'm afraid I've had an accident."

    Without complaint or censure she sorted both me and the toilet out. You really have to be heroic to be an NHS nurse.

    On the Friday I made a positive effort to try and count the number of pills and injections I was being given and it came to a startling 19 during a single day (including, of course, a regular stomach injection they give you to counteract the detrimental effects of the other pills). Now I have no doubt that given any particular drug they could give me a convincing reason for taking it. But that doesn't alter the fact that 19 drugs is just plain absurd - hospitalisation gone mad. I queried one in particular, a beta-blocker called bisoprolol. I said "I've been taking atenolol for 15 years. Why have you arbitrarily changed this?" Of course the doctor assured me that bisoprolol had been clinically proven to be 'better' than atenolol. But that misses the point. I knew I was safe with atenolol - there wouldn't be any side-effects. You can't say that with a new drug. If you've undergone a major operation then there's really only one aim - to get you through the next couple of weeks, not to change your regimen. They also gave me a drug called atorvastatin and I said "Surely statins are long-term drugs to limit cholesterol build-up over 5 or 10 years." The doctor agreed with me but still insisted on prescribing it. "But I won't be around in 5 or 10 years," I complained.

    Actually now I'm out of the hospital I can reveal that I ran a 'One Flew Over the Cuckoo's Nest' scam. They give you all the drugs in a little paper cup which you throw back your head and swallow. Since the atorvastatin pill was enormous it was very easy to hold that back with my teeth. Then I simply scrumpled up the paper cup with the pill inside and threw it in the bin.

    Since I mentioned John, the inspiring nurse, I should also name a Portuguese nurse called Caterina. She obviously regarded genuine medical work as preferable to mopping up urine, and she replaced my bandages with quite extraordinary care and attention, for which I was very grateful.

    During Friday a guy called Hector gave me an appraisal to see how I was doing (with the long-term aim of sending me home). He watched me as I got out of bed and then walked fifty yards along the corridor with me to see how heavily I was breathing. I knew I wasn't very good, but the strange thing is that after that day I realised I was getting gradually weaker. Here's the reason why:

    Obstreperous Patients

    Apart from my toilet disaster I was pretty much an easy patient. Not so everyone. We had one gentleman - I shall call him 'M' - in our ward who truly believed he was in prison. His only aim was to escape. It was impossible to explain to him that the only way he could get out of there was to get better. I heard him talking on the phone to someone I took to be his next-door neighbour at home. He was arranging for them to drive his car round to the side of the hospital where he would 'jump in'.

    The trouble was he wouldn't stay in his bed for longer than five minutes and he was also fairly aggressive to anyone who tried to control him. On the Thursday night he got up around 2 or 3 am and started berating the nurses. Eventually he attacked them physically and they had to call security.

    As a result on Friday night he was assigned his own male nurse who did nothing between 8pm and 8am but make him stay in his bed. Think of the cost of that.

    On Friday they moved him into his own private room, with his own toilet. Problem solved? Not at all. They were obviously not permitted to lock the door and throw away the key so the same male nurse had to sit up all night outside his door to keep him under control. Even so, I got up for a pee break only to find he'd escaped and was peeing in the corridor

    So sleep was at something of a premium in our ward. I found I was getting up about once an hour on the hour. I've got a strong belief that pain or discomfort is linked to the bladder by some nerve or other. Back in my schooldays caning was still permitted and several times a boy who was being caned would complain that he couldn't control his bladder. I think my general discomfort affected me in the same way.

    They actually apologised to the ward in general for the lack of peace, but after M was removed to his on room his bed was taken by another nuisance who I shall call 'B'. He must have been 'behind' me in the progression because he still had his tubes in. He had a huge bushy beard that they had not shaved, surprisingly, and he was very irritated by the tubes in his neck so that he picked at them till he had drawn blood. That sounds pretty dangerous to me.

    He behaved very much as a dementia patient, talking nonsense, walking round everywhere - he came and sat on my bed for a time - and was even more uncontrollable than M. On the Sunday night (after he'd had all his tubes removed) he kept walking round picking things up. I always put my glasses on the bedside table and I was absolutely terrified he was going to knock them off and tread on them. I shouted at him twice in the night, really loudly and really vehemently but his reaction was simply to smile and slap his own wrist. Needless to say you don't easily go back to sleep after you've seriously lost your temper with someone.

    Just to complete his story, on Monday one of our number was given the OK to go home (though he still had to sit around for 5 or 6 hours before he could actually get away). This got B very excited and he discovered he was to be moved from Southampton to Portsmouth QA hospital. As a result he kept asking the nurses when he was going and they said they were waiting for Portsmouth to phone them to say they had a free bed. B still kept asking the rest of us what was going on and why 'nothing was happening'. We kept wearily explaining he had an indefinite wait.

    This was about midday on Monday and he was so keyed up that I swear he never stopped talking (and walking round) from then till 6 am Tuesday morning when in desperation the nurses rang up his wife to ask her to come in (from Portsmouth). She did so and extraordinarily, when faced with someone he knew, B promptly fell asleep at last.

    My point here is that his energy seemed boundless. I could hardly get to the toilet without gasping for breath, but he was able to walk round for about 18 hours non-stop. I put this down to the wretched furosamide they'd been filling me with, though I have no evidence to back that up.

    Saturday, Sunday and Monday

    On Monday they let me have my first shower. I still had the bandage down the middle of my chest and various other bandages which the nurse told me to get wet and then peel off. I managed all that although I chickened out of removing the one on my throat. But the shower was a real struggle and I had to hold on to anything handy to avoid falling over.

    I was strangely prophetic at this point. I've mentioned the horrendous full-length scar on my leg. That didn't look any too clever to me and I complained to the sister that it was unnaturally painful (in particular my shin was stinging.) She looked at it and said it looked OK (which it certainly was not).

    On the Monday, six days after the op, they gave me an 'exit' test. A young lady made me get in and out of bed, showed me the correct way to sit down and get up from the toilet, and took me for a 100 yard walk to see how I reacted. The main point of this is to stop you using your arms because that can damage the graft which runs down from your shoulder to your heart. I failed the test and got very neurotic about getting out of bed without using my arms. I simply claim it's impossible. You can roll your body and legs over the side but you still need something to lever you up. I even got John, the male nurse to give me a little practice session but I didn't feel I was winning.

    Tuesday 3rd Sep

    This was just after B had had his hyped up session of walking round all night and when the doctor came round I complained in no uncertain terms and with some questionable language that I couldn't possibly get better with such a monster interfering all the time.

    "I failed the exit test yesterday," I said, "and I'm even more exhausted now than then."

    The doctor just smiled at me and said

    "Let's just take a positive view, shall we?"

    In fact I think he meant by this that he was going to instruct the exit technician to pass me. I was already medically fit to go home and they needed the bed.

    Going Home

    So around 11am they declared me fit to go home. I wonder what would have happened if I had said, "No, I don't think my leg is healthy. I'll stay in a bit longer." But of course I didn't. I was desperate to get out at any cost. All of this is strangely reminiscent of the last time I was in hospital, about ten years ago, for a bile duct blockage. Then I left, knowing the wound was still dodgy, it duly got worse, and the whole thing didn't fully clear up for 7 weeks.

    Having been cleared to go I phoned my wife and said I would be round some time in the afternoon. Although we are still legally married we have been separated for over 25 years. Since I was not allowed to go home unless there was someone there overnight, she agreed to come round and stay at my house for a few nights, a truly generous offer for which I am genuinely grateful.

    Now it is strange what a mess the hospital makes of discharging its patients. I had seen 2 or 3 go earlier and in all cases they were left sitting on the bed, clutching their belongings, usually with a wife in attendance for 5 or 6 hours, getting more and more angry. It is true that the pharmacy has to prepare their bag of drugs to tide them over the first month, but surely that's just an automatic job that doesn't have to take 5 hours.

    In my case the sister produced my drugs and went through them with me (no small task) and then said I had a taxi booked for 4pm. (I had driven in, a friend had earlier retrieved my car from the car-park which costs considerably more than Gatwick or Heathrow, so now I justified a free taxi home.) I needed a porter to wheel me down to the main entrance. 4pm came and went with no porter. He finally showed up at 4.40 and got me down to the taxi-rank by 4.50. Unfortunately he had no idea what to do with me once there. I was waving a docket that gave me a free journey, but only with the taxi I'd booked.

    Now I can't imagine any sane taxi-driver would wait 50 minutes for a local journey. So I was not surprised we could not find him. In the end I simply said that I would pay the fare, and I got one from the rank.

    Again, how can they make such a mess of something they must do a hundred times a day?

    Scattiness

    I've mentioned that your brain takes a hammering during an 8 hour anaesthetic and I think this is one of the reasons so many patients seem to cross the boundary into at least temporary senility. I found myself confused about several things and I'd been trying to do crosswords with an astonishing lack of success.

    In particular I managed to lose my wallet. I subsequently stopped the cards without loss, and indeed some 4 weeks after my op the hospital found it in the patient property box in one of the many wards I went to. That I should so totally have forgotten having it put there shows just how woolly one's brain gets.

    Apart from scattiness I also felt I was sufferring from a serious lack of motivation after the op. This blog, after three weeks, is quite a red-letter day since at last I've buckled down to doing something tangible, whether pointless or not.

    I have a computer game against which I sometimes play bridge. I tried this a couple of days after I got home and at one point I was completely flummoxed by the bidding sequence. It was a strange feeling. To play bridge you have to remember the bidding sequence, but I just couldn't get my head round it at all and I gave up trying to play.

    I am glad to report that I seem able still to play the piano. Whatever part of the brain controls rhythm still seems to be working. While I was in hospital I often thought how nice it would be to play something, but now I'm home I seriously lack the initiative to either play or practice.

    Hemorrhaging Money

    Ever since the National Health Service was put forward in 1943 the country has been persuaded that being ill is not your own fault and that the 'state' should therefore cover the cost of treatment NO MATTER HOW GREAT IT IS. Few people would put a cap on what you might have to spend to 'save someone's life'.

    Now it's nonsense to talk about saving someone's life. Since we are all going to die eventually all you are doing is prolonging someone's life. Therefore it's mathematically obvious that prolonging an old person's life is not as valuable as a child's or a teenager's.

    It's difficult to find a cost for the operation I underwent. $106,000 is quoted in Cleveland, Ohio, $20,000 elsewhere for the surgery alone. I think 20,000 pounds is probably a fair figure for the op and hospital stay.

    22% of patients in NHS hospitals are over 85. 25% of patients suffer from some form of dementia.

    Increasing longevity has contributed to the ever-growing proportion of a country's GDP that gets spent on health-care. The figures take some believing. This is from the UK Office of National Statistics from May 2011.

    So there seems little doubt that we have to do something about it. I can't see coercion ever being acceptable. Even to charge older patients some proportion of the cost is quite unreasonable. Destitute patients would have to be funded by the state, and that means that those that have saved all their lives are being hammered at the expense of those who haven't.

    My solution is choice.

    We have to change the mindset of the public and in particular of the NHS to accept choice as being reasonable. Don't just drive every patient on to the inevitable surgery but suggest they might live without it and thereby avoid the horrendous trauma it causes. This would have to be accompanied by a system of palliative care that accepts that the patient is eventually going to die and makes it as bearable as possible.

    This may sound pretty lame as a way of saving money and indeed it would take some years to have any effect. But that's a good thing. It means no violent change to the status quo. But gradually older patients might see that a palliative twilight could be preferable to a holocaust.

    Wednesday 4th Sep

    My first night home was really awful. I spent the whole night going to the toilet and in the morning I just felt like death. I rang the district nursing team up and asked them if someone could call and a young male nurse named Pete came round. All I really needed was reassurance and I have to thank him for providing it. I had got myself into a real state about getting out of bed without using my arms. I could not do it. He simply explained it couldn't be that critical and that I just had to take it as gently as possible.

    Two other things that quickly went by the board were my anti-embolism stockings and a strange wooden bra that I'm supposed to wear for the first month. The stockings are simply quite impossible for any patient to get on and off and indeed one of the nurses had told me at the hospital I wasn't going to be able to use them. The wooden bra is, I believe, supposed to protect you against a violent sneeze by stopping you bursting your lungs apart. I would like to know whether it's ever been used in anger. It's diabolically uncomfortable and I'm amazed that I managed to sleep in it at the hospital.

    To follow up on my call for more choice, if they had asked me whether I wanted to wear the bra or risk exploding I would have taken the exploding choice. A good night's sleep (which I never got) would have been medically well worth whatever intangible risk I was taking. And it would have saved the NHS money, since they give you these things to take home. But of course that's not the way it works. The nurses bully you into wearing the bra. Comfort is not a consideration.

    I was never given any choice about the stents, either. Now I don't doubt the doctor's diagnosis that I needed a bypass in order to live a normal life. But that should be my choice. They can put stents in at a tiny cost compared to a CABG (they can do it when they do the angiogram). Perhaps then I could have gone home and spent the rest of my life walking very slowly, but that could be preferable to being brutally battered half to death.

    My daughter came round later and nursed me down the road to the NatWest bank (only 100 yards away) where they were wonderfully helpful and arranged to cancel and replace my cards.

    Thursday 5th Sep

    I am very lucky to have a local doctor's surgery within 100 yards of my house. I limped there on the Thursday and he dutifully copied all the new drug information into my file. I showed him my leg which was hot and red and he prescribed flucloxcillin, which I think may have been the same anti-biotic the hospital alreay had me on.

    This was the first day I took a pain-killer.

    Paracetamol

    I had stoically avoided pain-killers till I got home and gave up the battle. Then I was amazed at just how delicious paracetamol is. In the hospital the nurse would come round last thing at night and say:

    "Anyone want any pain-killers?"

    Everyone except me put their hands up and it's easy to see why. They make a lovely, fizzy drink and they have the added side-effect of numbing some of the misery. What I discovered, at home, was that they also have the beneficial effect of making you get up less often in the night, presumably because they numb or mask the signal from your bladder to your brain. Instead of once an hour I was suddenly only getting up once every hour and a half. That's worth a lot.

    The strange thing is that of all the plethora of drugs I was forced to take paracetamol was the ONLY one that tasted nice. Why? They gave me some Sanatogen multi-vitamin tablets which tasted absolutely filthy. When I got home I went to the chemist and said "I can't take these," and was rewarded with their own brand which was tasty and chewy.

    What's going on? Where is the benefit to the NHS of dispensing vomit? The only result is that, like me and the atorvastatin, some patients will find a way to avoid taking them.

    Sunday 8th Sep

    So now I had nothing to do except recuperate. Trouble was, as I'd feared, my Stanley knife leg scar had other ideas. By Saturday night it had swollen up very badly. It woke me up on Sunday morning and I decided to go back into the hospital. I obviously couldn't march back into my ward so my only choice seemed to be to go to A&E (again), this time by taxi. However I was not armed with the magic words 'chest pains'. I explained to the receptionist that I had recently had a CABG and said the donor leg was in trouble. I think she just regarded me as someone complaining of a scratch on their leg.

    After about 15 minutes a nurse saw me but was also not very interested in my woes. I showed her my leg but she didn't really look at it and sent me back outside to sit on one of their hard chairs. This was at about 6.30am so there was no one else there. After an hour and a half I gave up. Now many people will scoff and say they've waited ten or twelve hours in A&E. But I was still in a very weak state. I could scarcely stand and sitting was agony. I asked the receptionist if there was somewhere I could lie down but she said "I can't make special cases". At the end of my tether I simply gave up and caught a taxi home, 30 pounds the poorer with nothing to show for it. I reflected that if I'd rung 999 for an ambulance they would have HAD to do something with me.

    In retrospect I was quite furious about the way I'd been treated, though in my weak state I didn't have the punch to stand up to them. I WAS a special case, whatever she said. The hospital had got me into this condition and I deserved some help getting out if it. What really annoys me is that in the world of hospital statistics I shall go down as an entirely successful CABG operation, yet I wasn't. They failed to use the necessary care when carving up my leg and they failed to recognise, when I told them, that all was not well.

    In effect this episode encapsulates all that's wrong in NHS mentality. When I went into A&E complaining of chest pains I was in no great discomfort. I had just driven across town and it was 36 hours since my heart attack. I didn't believe I was about to die. But another heart attack WAS a possibility so suddenly it was all bells ringing and: we must 'save the life' of this 75-year-old man no matter how huge the cost.

    When I went in with my bad leg I was in real distress. I could scarcely walk, my speech was hesitant, and I was in considerable pain - all due to the hospital's own incompetence. But my condition wasn't 'life-threatening' so they felt justified in ignoring me till I went home in despair.

    In retrospect I can see I was too ill to go to A&E - you need to be fit enough to withstand their entry criteria.

    Wednesday 11th Sep

    I was reflecting on how I would feel if I had to go into hospital again and my immediate sentiment was "I wouldn't have access to the Internet." That might sound like a side-issue but it really isn't. In hospital you are cut off from the outside world and unable to leave - both characteristics of being in prison. Lack of Internet excaberbates such feelings, and it's so downright unnecessary. Even the public shops in the foyer are disallowed from providing WiFi points. The excuse is predictably "security". But that's obviously nonsense. If it means they don't want me to broadcast internal hospital details, then that's true in the short term. But they can't stop me publishing them once I get out, so it's of no long-term significance. If they mean they don't want me receiving intelligence from outside (which is what I want) then their spite is beyond credibility.

    My guess is that they gave the contract for 'entertainmant' to a private company (who provide television and telephone) and at that time they signed an agreement banning Internet access to give the company more profit. I should admit here that you can get very limited access through this service (where you have a 'TV on a gantry' over the bed), and that I did manage to send one Email using it. But it's virtually unusable and took me half the morning.

    I have two long-term contracts which I use at home, one with Emusic which enables me to download 30 or so tracks per month, and one with Gamepass that allows me to watch recordings of recent American football games. These cost me good money and would have provided perfect entertainment when bed-bound. Clearly you can't download anything on the TV-on-a-Stick because it's not electrically connected. Gamepass could have worked but didn't because the player support isn't installed. I also needed to send a raft of Emails when I was first impounded updating people on my status, but that was impracticable.

    It was like being in a Victorian workhouse.

    Friday 13th Sep

    I went to see my GP again. He agreed the leg looked a lot worse and prescribed another anti-biotic, clarithromycin.

    Tuesday 17th Sep

    It's now exactly 3 weeks since my op and my leg looks like this:

    Bear in mind this is not a shark bite or perhaps the result of dropping an spinning chain-saw but a surgical cut made under supposedly sterile and unhurried conditions.

    After two solid weeks of anti-biotics I have to hope the wound is at last beginning to heal. All I can do is wait and keep taking the paracetamols.

    Conclusion

    Think long and hard before accepting a heart bypass operation.

    It would be nice if the hospital gave you all the warnings it should, namely:

  • Your brain will get mushed by the operation (but will hopefully recover).

  • You will find yourself in a ward with people who's brain is even more mushed than yours and you will hate them.

  • You will be prone to infection. The rate is probably around 10%, with leg infections twice as common as chest. Infection around the shin region is diabolically painful because of the constrained blood flow.

  • You will get fluid in the lungs as a result of the op (because you are put on a ventilator) and this will cause you to cough painfully.

  • You will be given a bewildering surfeit of drugs which you will not be allowed to question.

  • You will probably get sent home sooner than you should be (to save beds) and you will not have the guts to question this (everyone is desperate to get out of hospital as soon as possible).

    Now, in my current state, it is always a danger that I might contract some infection of the new bits they've put in my chest. Or, more oddly, there's a disease called Endocarditis which affects replacement valves and can be a side effect of any dental work (it infects via the mouth). Under these circumstances they will undoubtedly offer to open me up again - hang the cost - and sort me out. One patient in my ward had indeed been operated on twice and was still in pain from an infection.

    All I can say is I don't have his courage and I want to formally state here that I do not give my consent for any second operation. Life is not that wonderful after 75 and death would be a preferable release.

    Addendum

    It is now Sep 26th, 4 weeks and 2 days since I had the bypass and my donor leg remains as painful as ever. The problem is far worse when I'm horizontal (i.e. trying to sleep) and I have found it virtually impossible to sit or lie with my leg raised (as is advocated).

    On Tuesday of this week I would describe myself as having been in excrutiating pain more or less continuously between 2.45am and 3.45am, when mercifully I did manage to get to sleep. They have put me on a stronger pain-killer (Codipar, which is a combination of codeine and paracetamol) but I can't say I've noticed any difference.

    On Wednesday night (last night) the situation was even worse and around 3am I simply gave up trying to sleep and sat and watched a video on my computer. I nodded off for ten minutes or so by virtue of sitting in a comfortable chair rather than lying, but other than that I was awake till breakfast.

    I've been reading up on post-CABG infections and indeed leg infections are twice as common as chest wound infections. This chart is from the National University Heart Centre, Singapore. I couldn't help wondering what Southampton's chart would look like, if they made one. I don't believe they have ever registered me as having an infected leg, and I can imagine that's true for well over 50% of exit cases.

    One other document I saw mentioned 45% as an infection rate. If the pain suffered on average is anywhere near my experience then we have a microcosm of misery of chronic proportions that they should (at the very least) have warned us about. In particular Southampton Hospital did not tell us to sit with our legs raised, yet if I had done that when I still could I might have been spared this agony.

    As Homer Simpson often says: "This is the worst pain ever." That's how I feel each new day - or rather night.

    Sequel to this Blog: The Next Three Weeks

    Necrosis