My near experiance with Death...

LET ME SHARE……….

It was just another routine call on 10th July 2013. Around 4 am, almost at the twilight zone of the call had just returned after admitting following resuscitation of an attempted suicide.
Though not exhaustive and still strong had come home to catch some precious sleep in the early hours.
Mild pain burning in nature in the centre of chest behind the sternal bone. Nothing to panic about, it has been before sometimes rarely and antacid has been my refuge. But this time it was not much in the bottle and also had passed its expiry date by more than a few months. My next choice was diclofenac ointment and naturally opted for it.
Not knowing the seriousness, I did manage to sleep up to 7 am and had to wake up and allow the maid to come in.
By 9 am the pain restarted, was becoming a bit restless also and asked the maid to finish fast and move out. Plan was to buy a new bottle of antacid, inform Dr.Datta to assist for an ECG AND CARDIAC ENZYMES, and in between should go to bank and send money for my son.
Did them all, manage to peak into theatre entrance and called the boss, he assured nothing serious will happen
Again in ICU as a courtesy for a colleague, blood was drawn for cardiac enzymes
Pain continues, and is becoming intolerable
Dr.Bekele was concerned, obliged to my request, organized a wheel chair and pushed me to A& E.
Drama now starts, everyone is around all are my friends, everybody wants to assist. Resident follows the protocol, Nurse starts taking history, oxygen on face, vitals monitoring initiated.
Repeat ECG requested, brilliant idea, Resident insists in spite of excuses that it was done just fifteen min ago... hmm what a shock the ECG IS ERRATIC , though in sinus rhythm , this STEMI –Ant.wall .
Now no time to waste, Dr.G, the cardio has come, instructions flow, chew aspirin, shot of heparin, sc clavix... Here comes the tough task, ‘am in shock, am I marching towards to the end?
Pain is intense. NGT sublingual given... no benefit, repeat after 5 min,” ‘am I having headache? “Somebody shouts. Cannulation, finding a vein is very difficult, so many pricks, yet no access,
The one who succeeds is the middle aged sister on whose skills I always NEVER relied upon and use to ignore or even neglect in my good times. Angels are recognized only in crises.
Morphine was jagged, I surrendered myself to BABA the moment I heard STEMI...
Decision to shift to Bokomosa for Angio urgent and proceed…

Arranging Ambulance, Oxygen cylinder, escorts …. Lots of work... yet they all did.
Boss and Datta escorted.
Dr.K in theatre attire accompanied sat in the ambulance, On the other end Dr.R alerted to be ready.
Dr.Rao received, Monitors connected, ECG HAS CALMED DOWN NOW, st back to normal T wave inversion... yet the clot has to be blasted. Dr.R did not hesitate, Inj.Metalysin (Rs 40,000 in India)
Was pushed slowly up to 8ml based on my weight.
They all were glued to the monitor blood drawn for cardiac enzymes again.
Provisional diagnosis: ANGIOSPASM?
Management strategy: anti coagulants, anti lipids, anti glyceamic, waiting for angiogram...
Shift to ICU, close monitoring…
Family is far away, am in critical state not conclusive of my prognosis...
Hell is a better place to live than to suffer being away from family lying in ICU, with an unpredictable prognosis…
Being Pain free, was wondering why not move away? But on such an act what if I moved away for good???
My friend it’s my worst moment in my life….

 

LET ME SHARE ….. ( Part 2 )
One of the annoying things in life the sickening feel of being sick... “ Why me ? “ is the next thought that always pops up and slowly transforms to a question “what went wrong ?”, when the mind starts to accept the reality and once having surrendered to the guru the next phase is “what next now ?”
With much difficulty I did pass through all these whilst I stayed in ICU for 48 hours with all the wires and probes connected to my body and the constant regular beep sound with the monitor behind my back .
I was free of pain, slept well and how worse it was I understood when people wake me up and say “sleep well “.
Oral medications clevix injections, blood for tests twice daily and bland food, I was taken care...
Back home wife and younger son (planning to go for US shortly), another son in USA concerned of his future based upon my future! So many in limbo. Bro-in law critical, terminal stage of cancer cheek with metastasis…
Moved down to High dependency unit after an uneventful first 48 hrs... but still like the after shocks that follow an earthquake, people were anticipating disasters rather than recovery!! Sometimes we fear death more rather than fancy a better life.
Amongst the two Cardiologists, the other guy was very keen to make me oblige to get an angio done.
My attending cardiologist was more understanding and was not keen to subject me to risks when family is not around but at the same time he was hesitant to compromise on protocols.
Many thanks to his expertise and patience and above all Babas guidance, he delayed till Saturday.
On sat morning he said he will observe for one more day and then discharge me on Monday morning.
But later in the evening on looking at the ECG, he started to suspect some changes which he was not sure if they are a late reflection for the damage already happened. So now he said, “Siva, you will still be reviewed again tomorrow morning and if there is an increase in the changes you have no choice but an urgent angiogram and proceed “… hmm it’s back to square one again!
Informed home, and just left to HIM..!
Come next day, Dr.Rao called me to his office, ECHO done Ejection fraction quite good, no wall abnormality... Next is a big risk, subjecting me to stress treadmill, which was the final to clear me out for travel... For me I did not feel any change in routines, I did the stress treadmill up to moderate level and then he said with a smile I can travel with medications ( NGT Spray ).Good news, on that holiday morning he wrote the discharge summary , prescribed the medicines and wished me a safe journey..
By 10 am I was out of hospital seeing the sun again, went straight to Anand’s house (my friendly travel agent ) , he had booked the ticket for the next day ( 16th July) jhb –mum-chen. To start at 0730 at GABS, 1230 at JHB, will reach Mumbai midnight, next flight to Chennai 0330...
My next stop was to the electronic supermarket at the Mall to buy a small gift of hand held cd player for my mum to whom I had not bought anything for the past eight or so years.
Came home, Rajasekar and Mani my guardian sons were with me...
Few friends had come, Mrs. & Mr. Singh bought lunch, and Singh gave me the NGT spray (a few months ago he had similar drama and got the angioplasty done)
Dr.Addanghi had come with her husband and on seeing me climbing the steps, she declared that I had no heart attack!!
Good people with all good feelings... My mentor, Prof.B.Samy at that age had come to see me and regretted that he knew only that day. He had a reason extra, he recently lost his son in law due to heart attack who himself was a doctor and the daughter and granddaughter and her husband were all doctors!! For a long time he was holding my hands and I could sense the feeling...
That evening I stayed at Mani’s place, it was for my safety and also easier for them to drop me to airport.
Next day all my five boys had come, boss had come so early to airport (he was substituting my call on that day)... It was a silient send off (to where? nobody cud predict but only pray for safe passage)
First leg was very nervous, on reaching JHB to carry my laptop and handbag was I feeling tired? Will I fall down?? So many thoughts, yet this is the only way, let me move...
The biggest RISK in life is taking NO RISK...
But will one risk his life for his own life???
No choice, it was Hobson’s choice now... move. Saravan’s child was sick yet his wife had made chapattis and had rolled and packed them nicely, Paartheebans wife had put in idly with sambhar for the lunch...
After a bit of patience I did manage to take control, But to me it was like this: I honestly did not feel any change in my body, it was more the thought of declaring myself as a cardiac patient that was slowing me down... It was ok, the long haul from JHB to MUM started, I enjoyed the food, watched some nice Hindi movies (burfi)... it was cool, as it reminded me the place of my closest distant friend in North east India.
I had a roaming number, so was informing my people at the departure and arrival sites periodically.
Reached Mumbai safely after being in air at high altitude for more than 8 hours unaware of the true state of affairs regarding the blood supply for my heart...
Travelled alone 8 hours with an impending potential risk for complete block of one of the major artery of the heart... please refer: http://en.wikipedia.org/wiki/Widow_maker
Still cool, I had my medications after I had my supper at midnight in Mumbai... rested and the Chennai flight was fine, I slept...
Back in Chennai, in the early hours (0530), seeing my family we were all relieved...My friends , my 5 boys in Botswana and my family here all sighed in relief..
My brother had earlier arrived from USA that same morning and was much relieved...
This is the end of part 2, more surprises follows keep reading …

 

 

Let Me Share (Part 3 )

 After arriving in Chennai, I was just the same as ever before. But for the expected tiredness of the travel, it was no different.
Went home, slept well after a moderate breakfast, mum visited .She is a very strong lady mentally and recently had a stent block which ended up in cardiac arrest and successfully recovered.
She had terrible problems, both son and son in law are ill. Home front was disappointing and more stressful. Yet there was no other better place on earth for now...!
That evening I submitted myself for an ECHO and ECG with cardio in my hometown. Good thing about Tamil nadu in particular is that health facilities are cheap and easily accessible...
The cardiologist was surprised but for the minimal persistent ECG changes, He said the echo was absolutely normal and could not believe that I had an attack.
Next day by appointment I went to MADRAS MEDICAL MISSION and greeted my Cardiologist Dr.Ezhilan, who made a quick review and said let’s do an angio and conclude.
On 19th, was wheeled in to cath lab at 10 am, after adequate prep. I was shaved completely anticipating all emergencies, including bye pass if needed.
An 18 g cannula was secured in place, no premedication given, shifted on to table.
The nurse introduced herself and started to paint me with antiseptic solution and drapped me with sterile sheets. A dedicated nurse was monitoring the Spo2 and the cannula, on entering I saw a Boyle’s machine, no ventilator and I could not identify if any resus equipment was nearby, but I am sure it was around.
After a while Dr.E entered, greeted me and introduced me to his colleagues. With him was Dr.Kalaichelvan, another Consultant. Let me admit all these guys working in this mission hospital are great guys, very experienced, fully confident and well organized. The credit is not only to the doctors but all the staff from consultant to cleaners are stars in their specialty.
Dr.E said he was giving the local anesthetic which was the only painful part of the whole procedure
I imagined myself how many times I had been like Dr.E whilst doing central line cannulation in femoral region...!
Minutes moved as seconds, it was all fast with a running commentary by Dr.E.
Hmm, the shock is now revealed the left coronary artery is free but the Left Anterior Descending artery had a >80 block proximally. The right coronary had an abnormal origin was difficult to visualize but confirmed free and so does the circumflex. So the verdict is LAD block, but how did I survive, because a block of this artery is immediate death!! It’s even nick named as “Widow Maker “..!
When we escape an accident we credit it to FAITH, when we succumb we console it with FATE.
But let me tell you, since I still remain alive to narrate this incident, please practice simple exercise like walking, for it helps to develop collaterals if a compromised arterial supply exists and these collaterals will keep you supplying for the heart muscle in case the main artery gets blocked. And that’s what happened in my case. And that’s what made me fly in mid air above sea for > 8 hours without risk .Thats why my ECG remained normal for long and acutely changed for a short while when the arteries went to may be spasm due to pain. Not sure of the above explanation, but this answer fits in well. Dr.E was slightly concerned about inserting a stent at the same sitting because the block was soon after a branching and the time duration I was so far on anticoagulants etc.,
Getting a second opinion from another consultant who was also glued to the monitor, the decision was approved. Immediately another second cannula was in place. A shot of sedation given...
In a few seconds the balloon was in place the block blasted, Drug Eluted Stent in place... The post stent flow was 100%. I need to mention here that, I re experienced the same unique pain momentarily for a few seconds when Dr.E had placed the balloon in the block.
Hmm … it’s all over now... He took his gloves off and said it was very successful and when he wanted to show me the pics I said, I did not feel like seeing... But I could sense the pride in his voice and that boosted my confidence that a good job has been done... it’s enough I don’t need any explanations more.
Outside my wife and son waiting for the outcome. Dr.E went out to tell them it was all fine now.
I wonder if they ever understood for all their eyes were looking for me coming out conscious.
I was wheeled out, politely offered some tea... After a small time stopover in recovery room, was bought down to CCU, The next bottleneck, Heparin has got to go, the femoral artery cannula has to be removed and should not form a big bleed or clot... severe compression was done.
Another unique complication I was shivering a lot, lots of blankets did not help, and the BP had dropped to 70/40 but no compensatory increase in heart rate. But the staff were cool, its experience they just pushed increments of normal saline and a shot of avil (pheneramine maleate), which settled the shivering. Avil removed Evil...
After 6 hours, under his supervision, the cannula was removed. The Bp was slowly settling yet it was positional dependent still. I slept after a warm supper.
From now it was marching towards my way out of the hospital...
Anti coagulant, Antiplatelet, Hypo glyceamic, statins, beta blockers and ACE inhibitors… hmm I was wondering whether I was taking drugs to remain alive or ‘am I alive just to take drugs… it was confusing...
Statins have made me weak (destroys muscles causes muscle pain), blood sugar fluctuations and a bumpy blood pressure were competing with each other to destabilize my stability..
Yet after three weeks now I am not sure if I am perfect or still compromised in health... Its ok I feel as I was ever... My only problem now is I do go into some sort of shortness of breath whenever I think that ‘is a Coronary artery disease patient.
Restrictions on diet, activities, drug dependency are very much limiting factors which has dropped an invisible veil of sadness and depression… Time is a fourth dimension which will slowly erode this current state of affairs... hopefully.
Till then I wish every one of you individually to remain healthy and review your lipids, sugar and blood pressure periodically. Now that I have been reading more on this topic I intend to give you all a comprehensive idea on prevention of CADs (Coronary Artery Disease)