Tag Archives: Heart problems

A Long Delayed Post-surgery Update Here

Most of my blog readers here are, I believe, among my circle of personal friends, so most of you are well aware of my recent crises in life without reading about them here. Even so, as I am now able to do so, I feel that providing an update on my personal and philosophical perspectives regarding these crises here is in order.

For those of you who are not aware, I have had a relatively close brush with my own mortality lately, in the form of emergency surgery to treat major heart failure, and the long-term prognosis on this actually at the time of this writing remains somewhat uncertain. Three months ago, at the time of the TSC conference, this condition was, in hindsight, clearly beginning to set in already, but at that time I never could have imagined what was happening, or that it could come to such a radically life-changing point so quickly. Here is my best retrospective summary of the situation as I now understand it:

In the late winter and early spring I suffered a serious case of bronchitis, which was at its worst during the time of my second Kenya trip. I received various sorts of treatments for that illness, but its primary source remains largely shrouded in mystery. In any case, I looked at most of the health challenges I experienced over the spring as being related to after-effects of this event. During the spring it seems I was never entirely free of some form of coughs and aches, but I felt well able to go on with life, including purchasing and beginning work on my “country place” in the village of Matku. Beginning the deconstruction of the old farm house there also involved its own health risks in terms of moldy air and chances to injure myself, but in the current level of hindsight, that project seems not to have been the source of any of my later symptoms.

The first significant alarm to go off regarding my long-term health came about in April, while I was actually in Matku: I woke up there on a Saturday morning with no vision in my right eye. I have experienced temporary “grey-outs” of parts of my field of vision relating to stress and fatigue for many years, and I was told that such are quite normal for middle-aged men, so I didn’t panic in relation to this, but over the course of the day the vision didn’t return as usual; or it did only partially, for about half of that eye’s field of vision. For a few days I continued trying to go about my business as usual with it, waiting for it to sort itself out, but eventually I went to the health center to have it looked at, and was in turn referred to Helsinki’s main ophthalmological clinic for testing. I spent two days there as an out-patient, going through a battery of tests that never really got to the bottom of the situation. This may or may not have been the first strong hint that my heart was in trouble.

This combined with an increasingly disturbing cough over the course of May and June. I maintained my full, legendary vocal power through the middle of June at least, but increasingly as I spent time speaking with people I would have powerful coughing outbursts, combined with ever increasing dizziness and shortness of breath. Friends began increasingly to tell me that I needed to see a doctor about that, and I largely agreed. That wasn’t particularly convenient though: Presenting my coughing symptoms at the health center in June, they didn’t see anything urgent about the matter, and they did not have any non-emergency appointment times available until later in July. I had already booked flights to spend most of July in Kenya, and with that work being very important to me I decided to let it slide. So with an increasingly nagging cough and occasional shortness of breath, I left on my speaking trip to Kenya regardless.

I tried to pace myself carefully over the course of that trip, which still involved plenty of elements which would be physically challenging even for a perfectly healthy middle-aged man. I was able to keep up most of the time though, and able to control the cough during public speaking events by keeping sufficient supplies of bottled water and tea close by. Later on I will publish a more detailed account of the new perspectives I gained from the Kenyan visit; for now I’ll just say I survived it physically, but by the time I boarded the plane for home I knew I needed to get to western medical services as soon as possible.

I got back into Finland on a Tuesday evening, and got to my local health center first thing Wednesday morning. I was given an emergency appointment with a GP for that afternoon. The doctor in question was very young and obviously rather nervous about venturing a diagnosis with all of the variables in my case, but he had the laboratory there run an EKG on me, and from that he could see that things were not entirely normal. He sent me over to have tests at Jorvi, the local general hospital for the area, with his first concern being to rule out the risk that my violent coughing had led to a blood clot making its way to my heart.

I spent the next 7 hours at that hospital. They did a chest x-ray, more EKGs, more blood test and more stethoscope listening, without finding any clear evidence of what was wrong with me. By that time my heart was certainly down to less than 40% of its normal capacity, but they heard no murmurs and saw no clear sign of damage in the x-ray, so in the end they sent me home with a new inhaler system to ease my breathing difficulties and instructions to come back if things got worse.

The following day, Thursday, I spent running an errand of picking up my van from a repair shop where I had left it while I was in Kenya, and getting it back home to Espoo to be re-inspected for the year. That once again was an exercise in pushing my strength to its limits, and knowing that things were just not right. The next day at lunch time I returned to the health center, prepared to be sent back to the hospital for a longer stay… only that wasn’t to happen just yet. The duty doctor there looked at my paper work and told me that there could be no risk of heart problems after all the tests I had just had done less than two days earlier. She told me I was probably suffering from dehydration in addition to the cough, she wrote me a prescription for a heavier narcotic cough syrup and told me to go drink lots of mineral water. The help from that advice was marginal. The main thing it did was to cause rather sudden bloating in my legs and stomach area as the mineral water stayed in my system as excess fluid.

From there, with the school year soon to start, I took my business over to the city workers’ employment health service. The doctor there, who has the job of trying to keep city workers physically able to do their jobs, wasn’t quite sure what to make of my condition. He did all the routine examination sorts of things, gave me papers excusing me from my first week’s work, sent me to have more lab tests done, and told me to book another appointment with the secretary for the next week. The next week he told me that my blood was running somewhat low on iron, but that nothing else obvious had popped up in the lab results. They had ruled out a few rarer diseases that some of my co-workers had suggested might be the cause of my problems, but they didn’t answer the question of why I still couldn’t breathe or operate normally. So from there I was given another week’s worth of sick leave, sent back for more lab tests related to the anemia issue and told to come back again in a week. The next time it was much the same song and dance, but this time the order for lab tests I was sent away with included a fresh EKG. That’s where things started to move real fast all of the sudden.

It had been an early morning appointment so I went over to have the tests done right away. I had to climb one flight of stairs to get to the laboratory, and when the EKG was done 15 minutes later my pulse was still racing from that level of basic exertion. The lab tech took a look at the readout and said, “You should probably show this to the doctor right away.” So back across the street to his office I went. The doctor seemed more puzzled than anything else by the paper, but from there he said, “Well, just to be safe, the city can pay for you to see a private cardiologist on this one,” and he proceeded to write up the basic referral paperwork. So from there I drove over to the closest office for the private medical associates’ office that the city of Espoo has this sort of arrangement with, stopping off at school along the way for a brief chat with my substitute teacher, colleagues and boss. At the first office of the private medical company that I went to they told me that their own in-house cardiologist had his next available appointment time in a week and a half. I told them it probably needed to be sooner than that. They made a few phone calls and asked me if I could see someone in Helsinki already that afternoon. Of course. So at 3:00 in the afternoon on Thursday, August 20th I saw my first cardiologist. This veteran doctor read through my papers, ran a quick blood pressure check and EKG test of his own, took me across the hallway for a look at my heart with his ultrasound machine, and pronounced, “You need to be in a hospital!” The only new information he gave me was that there was a layer of fluid surrounding the heart over a centimeter thick, and that tests needed to be done to see where that was coming from. So from there it was directly back to Jorvi hospital with me.

The hospital’s cardiologist had already gone home for the day already by the time I got there Thursday, so they just got me into their stylish hospital pajamas and onto a bunch of monitors and under general observation that evening. To the best of my knowledge it was the first night I had spent in a hospital since getting out of the one I was born in over 53 years earlier. It was a pretty good run while it lasted.

Jorvi’s cardiologist arrived on rounds with his ultra-sound machine after lunch the next day. Notes from the hospital’s other doctors and my papers from the city health service hadn’t given him a clue as to what was actually wrong with me. He spent a while poking around and pressing into my chest with that jell-covered wand and after a period of uncomfortable silence I asked him it my valves looked OK. He said they looked quite good, and I was starting to joke about that side of things when suddenly his face went grey. “I spoke too soon about the valves,” he said.

He continued poking around and pressing buttons to capture images for a couple of minutes before he began to address my growing shock. The aortic valve at the bottom of the heart seemed to be entirely calcified –– frozen in place –– and the rest of the heart was literally fighting for dear life to keep some sort of blood flow going through this obstruction. This seemed quite clearly to come from a defect that my heart carried basically from birth, which had probably been giving a murmur before, but which, as it decayed further and hardened up with age, became less audibly noticeable in routine check-ups and the like. Now it had gone critical. It was clear to the doctor that I would need surgery on this right away, but he was trying to say so indirectly out of sensitivity to my shock.

The doctor packed up his papers and went to make some phone calls. He came back with a couple of the hospital’s young interns in tow about 10 minutes later to give them a quick guided tour of what a real live heart in critical condition looks like, giving them turns with the ultrasound wand to help them learn to track down such a defect for themselves. They seemed quite fascinated and appreciative of the learning opportunity. For me this was somewhat strange: I’ve always sort of wanted my body to be of interest to intelligent young women, but not quite in that way.

I was still laying there sort of digesting the shock when the cardiologist returned again, announcing that, because they would not have any heart specialists on duty at Jorvi over the weekend, he had arranged to send me to Meilahti: Helsinki’s main hospital for specialized heart treatment. As I started calling to inform my sons of this up-coming transfer I still had no idea that within 24 hours I would be undergoing massive open-heart surgery! But there it was. By the time the boys stopped in to see me in Meilahti that evening the surgeons and specialists had already taken a further set of high resolution images of my heart to guide them in the surgery scheduled for 9:00 the next morning…

My chest 15 days after the surgery.

My chest 15 days after the surgery.

So skipping over some of the details of the ups and downs of the recovery process since, that brings me to where I am now. For two and a half weeks now my heart has been pumping through a man-made valve, and trying to figure out how to relate to this new situation. It’s not as though my heart is saying, “Wow, now that you’ve got those restrictions out of the way I feel so much better! I can really get into this work again!” Nor is it saying, “What the hell are you doing to me? I can’t take this shit anymore!” It’s more of an in-between reaction like, “This is really strange. I’ve never tried anything like this before and frankly I’m not sure what I’m supposed to do about it. Isn’t there anything else you can tell me?” So they’ve been watching it carefully and trying to give it all the chemical encouragement they can to adjust to this new situation, but still with no guarantees that it’s going to work long-term. That’s sort of a freaky place to be at. All this beside the fact that I never really had time to prepare for the idea of joining the ranks of open heart surgery veterans to begin with.

So how have my religious and philosophical perspectives come into play here? What help has all my extra thinking on “the big questions of life” given me under the circumstances? What new thoughts and feelings come to mind in light of these transitions?

In some ways the experience is comparable to losing one’s virginity: Before ever having sex I sort of knew already how these things work, what sort of feelings should be involved and what the experience might mean in terms of the connection between my partner and I, but then there is a whole different level of understanding that comes with actually experiencing it. So it is as well with the existential experience of facing the possibility that your body has reached the end of its lifespan. Not that this is the first time I’ve realized that an ever so slight shift in recent circumstances could have resulted in my death, nor was it the first time I’ve realized that my body is showing signs of being past its prime; but I’ve now come to the point where I have to admit that, had I lived more than 100 years earlier in history, I would have inevitably have been dead now. I’m not that old, but for the body I was given I’m now on borrowed time already. That’s just the medical fact of the matter. That new experiential perspective does something to all of my contemplations of the meaning of life and all that where it’s almost like, “Yes, I get it more now.” Not that I felt like I hadn’t got it before, but there’s something about the actual experience of a strong encounter with one’s mortality that only comes with actually facing that experience.

The other significant thing that comes to mind in all this is the issue of finding a balance between maintaining a passion to live in every possible way and being at peace with letting go of things that I’ve always known were meant to be temporary. That’s one I’m still working on though. I’ll try to update you as I learn more about myself as that process goes on.

Meanwhile, however, going through this sort of experience, especially in the digital age, has given me wonderful opportunities to see the sort of warm and caring friends I have around the world. There’s something humbling about having people on six continents aware of my crisis, caring about what happens to me and in their own ways praying for me. I am full of gratitude for being able to have such a rich life in this regard. For those of you who have been part of this support network, may God richly bless you with the same sort of support you have given to me when you face your own times of crisis. I can think of nothing better to wish for you.

Peace, David

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