What to expect when your chest is sawed open

My previous blog, I discussed my impending open-heart surgery and posted it that day. Needless to say, I’ve been indisposed since then and haven’t felt like doing much of anything; but now, two months later, I’m recovering quite well.

I purposely did minimal research prior to my procedure (aortic valve replacement and aortic arch graft). I’ve worked in clinical healthcare for years, and knew enough to know that I didn’t want to know any more than was absolutely necessary. Besides, my wife and my mother did plenty of research and were more than nervous enough for everyone involved (which I guess comes with the titles).

That said, what information I did see was fairly dry and clinical. I thought I’d provide an honest and thorough personal account. So, if you’re facing an open-heart procedure yourself and want to know what to expect, or are just interested in what happens, here’s a walk-through of the things I discovered and/or were surprised about along the journey. Granted, everyone’s experience will vary, and, at 41 and in very good health other than the defective valve, I’m outside the demographic of the average heart patient. Some things, though, are certainly universal.

  • Yes, there’s pain, but… – Not as bad as I thought and not all where I thought it’d be. Coming right out of surgery, of course your chest is painful where your sternum has been sawed, separated, and wired back together. You figure out quickly how to move so as not to aggravate it further. However, your arms almost hurt more at first, especially around the armpits. This is because your arms are spread and pinioned out to the sides during the surgery, to be out of way. This fades and goes away after about a week. The chest pain gets better, but very slowly. I have no idea how long before it goes away. I’m not there yet. Although, now at two months in, I’d call it more “discomfort” than pain.
  • Tubes – You’ll be full of them at first, and most of them come out at about the same time.
    • The breathing tube -I was wheeled into the operating room, told to breathe into the mask and count backwards, and almost immediately I was aware that I was in the CCU and they wanted to take the breathing tube out of my throat (of course, over 12 hours had elapsed between one and the other). I was still pretty out of it, but I knew I really wanted it out. They gave me a countdown and ran water down the tube as they pulled, which caused me to feel a slight moment of panic, but the tube came out and it was over. Your throat’s a little irritated afterward, but not that bad and not for long.
    • Chest tubes – Three of them, inserted under the diaphragm up into the chest cavity to drain out fluids, and stitched into place. The pinkish liquid is collected in a box with a clear front so you can examine it. These tubes are removed right before you leave the CCU. They’re pulled out as quickly as they can be, which is very slowly. It feels exactly like you’d think a tube being slowly pulled out of your chest through a small hole in your abdomen would feel like. Three times.
    • Arterial line – This ran up into my groin inside the left leg, into the femoral artery. Honestly, I never asked specifically what it was for. It’s pulled out right before you leave the CCU. It’s not too bad, but then they put a 10 lb. sandbag on the site to make sure it closes, which stays there for an hour as you lay flat. Laying flat is highly uncomfortable for quite a while after a sternotomy.
    • Foley catheter – So you don’t have to get up to pee. You can figure out where it goes. It came out right before I left the CCU, and the nurse yanked it out like she was trying to start a lawnmower. I’m pretty sure, however, that’s the best way to do it. I’m also pretty sure I involuntarily said some bad words.
    • Central line – This goes into your left shoulder into one of the major veins in the chest. Meds can be administered through it, as well as blood taken. This stays until right before you leave the hospital.
  • They want you up – I was helped to get out of bed and to sit up in a chair before the sun came up my first night in the CCU. When I moved to a regular hospital room, there was someone there within 30 minutes asking if I wanted to walk. I had use a walker and only made it halfway down the hall, but it felt good. It got much easier as the week progressed. I would have walked out of the hospital the last day if they’d let me.
  • You’ll be weak at first – Amazingly so. I was helped out of bed to sit in a chair that first night because I couldn’t have done it otherwise. Walking was hard at first, but it came back quickly. Still, you learn that you can’t pick up jack. That lasts weeks and months. Either you don’t have the strength or it hurts. You can’t drive for several weeks because you don’t have the upper body strength to turn the wheel, plus it hurts at first. Take it slow. It will come.
  • Bodily functions are your enemy – My chest hurt, yes, but I figured out how to move and position myself to minimize the pain. Then I started hiccupping. One nurse stated that it was not uncommon, but they don’t know why some people do it and others don’t. I just knew it was painful. Sneezes are the worst. I sneezed hard about five weeks post-op, and even then it about made my knees buckle. Anything that builds up internal pressure is bad. There’s a reason you’re given stool softeners.
  • Hospital food – Actually not that bad, but I didn’t really want to eat much of the time. However, if you don’t call to order, they call you. I was on the “heart diet” which is low salt and fairly bland.  I lived on veggie omelets, tomato soup, and chicken salad wraps. Aside from the day I was discharged, my favorite day of my hospital stay was when my wonderful wife brought me Starbucks (decaf, of course).
  • It’s downhill after three weeks – The first three weeks are rough. The first was in the hospital. During the next two, at home, there were some issues and subsequent adjustments in medication. My heart started palpitating wildly. I got really weak and dizzy. After an EKG, it was determined it was part of the process of my heart finding its rhythm again as the inflammation decreased. Meds were upped, no more problem. Meanwhile, I gained 14 lbs. in water weight in 6 days. I was bloated like a stuffed sausage. Meds were adjusted, and I peed out about 20 lbs. of water weight in 7 days. Good times.
  • You won’t look good… – The first time I saw myself naked in the mirror after I got home, it was startling. It looked like I’d been in a train wreck. My chest and abdomen were mottled purple and yellow from bruises in various stages. The inside of my left leg, down to my knee, was entirely purple from the arterial line. Aside from the vertical scar from the sternal incision, there are the three small horizontal ones from the chest tubes, and another long one on my right shoulder from the bypass machine, so my brain wouldn’t die while my heart was stopped.
  • …but everyone will tell you that you do. – Most times I’ve seen someone since the surgery, I’m asked, “How are you?” I answer, and then am told, “Well, you look good.” I’m starting to wonder what I’m supposed to look like. Whatever the case, I’m happy for the compliment, and know that it’s probably exactly what I’d say to someone else in the same situation.

Other than all that, it’s really just a matter of moving when you can, and resting when you don’t feel like moving. Life’s almost back to normal. I’m working out now (very low weights) and building back my strength. I actually lost upper body mass, and my right shoulder is weaker from where it was cut through for the bypass. You couldn’t tell I had heart surgery two months ago, unless you hear me clicking. My heart clicks now due to the mechanical valve. I thought it would bother me, but it doesn’t. In fact, it’s kind of comforting.

 

 

Photo: photo credit: djwtwo <a href=”http://www.flickr.com/photos/40761412@N00/26401286012″>…and It’s Okay</a> via <a href=”http://photopin.com”>photopin</a&gt; <a href=”https://creativecommons.org/licenses/by-nc-sa/2.0/”>(license)</a&gt;

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