Friday, November 26, 2010

Bypass Bypass

Our first-born, and so far only son, Alok, has suggested a few times that we write about our recent coronary artery bypass graft surgery. Called CABG. Pronounced 'cabbage'.

We held back for over two months. Partly because everyone who experiences a major medical event talks about it. And partly because we wanted some time lapse to ensure a degree of objectivity. We finally decided to write. Mostly about things we did not hear from others.

Bypassing the Cardiologist

It all started when she looked deep into our eyes and said "I need to see what is cooking in your heart".

In another day and age, some six months earlier, hearing such a thing from someone as comely as she is, our heart would have skipped a beat. But given that we had failed two successive stress treadmill tests and that she is our cardiologist, the heart stood firm and took it on the chin. In the context of recent episodic breathlessness, she was prescribing an angiography.

She was off the next day for a trip abroad and the procedure would be scheduled on her return. However, after further breathing distress, we were referred by a friendly doctor to another highly regarded cardiologist. He agreed that an angiogram was called for.

That is how, a week later after playing 18 holes the previous day, we landed up hale and hearty in the Cath Lab of Manipal Hospital. Within what seemed like minutes we were re-garbed in striped hospital pyjamas, wheeled into the procedure room and a Florence was pulling our pyjama bottoms down while another one was exclaiming "small prick".

Aghast at the insolence, we were about to protest when she injected the anaesthetic and we realised that she had just been reassuring us about the needle. In short order the doctor had inserted the catheter, injected the dye, looked at the result and was telling us "Mr Manchanda, an angioplasty will not do. You need multiple bypass grafts."

With these fine and comforting words he left us in the hands of the Florence duo to brief our anxiously waiting family. We were wheeled into the Cardiac Intensive Care unit and left to stew in peace while a few Florences fussed around.

After a while Alok and our favourite wife Kusum, both looking slightly dazed, were ushered in. Over the preceding twelve months they had dealt with the protracted terminal illness of our mother. We couldn't even begin to imagine what was going through their minds. We dared not think about what they would have to put up with in the coming weeks. All we could say to them was 'Aal eez well'. Apparently a popular catch-phrase, that we didn't even know we knew, from a recent Hindi movie.

A couple of hours later we were wheeled into our suite where we were to spend 24 hours. Under observation and the tender ministrations of Florence One. Talking some with Alok and Kusum. Mostly sleeping or playing with the dual-remote control, motorised, multi-section, all singing, all dancing bed. Plenty of scope for a fit minder and a bored patient to have lots of fun.

Before discharge the next day the family had another session with the doctor. We all saw the fine film starring our 'dil' again. He advised that while no adverse event was imminent, we should start planning for surgery. He suggested a chat with his colleague, the head of cardio-thoracic surgery.

The surgeon saw the film, declared it a hit, and agreed with the cardiologist. No surprises there. He then briefed us on what to expect in surgery including the procedure itself, risk factors, after effects, rehabilitation and recovery. He commented on our general good health and strong heart musculature to indicate that the risk factor would be much lower than the 2% general average. Over the next week or so we would talk to him again and again with questions as they occurred to Alok, or Kusum or to me.

Basically what happens in CABG is that the rib cage is hacked and jacked apart to reach the heart. The affected vessels are isolated and alternative routes provided for blood to flow. Then everything is sewn back together - the bone with steel wire and the skin with dissolving thread. The main graft uses the internal mammary artery (who knew we had one? and to spare!). The other grafts use arteries or veins drawn from arms and legs. We would need at least three grafts.

While the heart gets a new lease of life, everything else gets jiggered up in the process and has to be rehabilitated.

It occurred to us that the doctors we were meeting were far better communicators than most people, including communication professionals, we had come across in decades of corporate fooling around.

Next 
On To The Theatre