Friday, September 11, 2015

A Week to Live?


What would you do if, just maybe, you only had a week to live? It’s an interesting question to be sure, but I’ve faced it before. In 1999 I had open heart surgery. It was scary. Hearts were never intended to be cut opened and operated on. Obviously I survived. The operation fixed the immediate problem but not the underlying problem. Now, having entered heart failure for a second time, I’m faced with a repeat operation. By the time you read this blog, I will either have survived, or not. So what does one do during what could be his last week of life?
I have given the question a lot of thought, beginning with the first operation 16 years ago. That’s when I realized my planning needed to start then, not in the last week. So I took care of all the long-range stuff—wills, powers of attorney, medical survival forms, organ donations, and the like. I also ensured my spouse had a home and enough money to last her lifetime if I passed prematurely…and no bills of any kind. That planning meant my last week is open for whatever I want to do with it.
So, here it is. I am eating at great restaurants, drinking one or two drinks a day, playing board and card games with friends, and spending time talking with my wife and sister-in-law. I’ve caught up on e-mails to friends and written a letter to thank my wife for the 23 wonderful years we’ve had together—a letter she will only receive if the operation fails. I also refuse to sweat this last week. No yard work. No chores of any kind; just relaxation. I’ve read a couple of novels I have had on my Kindle for about a year, and watched a number of movies I wanted to see when they first came out, but did not take the time to do so.
I am not making any attempt to “resolve” issues with anyone who has been mean or inappropriate to my wife and me. I don’t need that stress. I have lived well without mean people in my life, and I certainly don’t want to invite any into my life now. If I make it through the operation, why would I want such people back in my life anyway? I know, I know, there’s the concept of forgiveness an all that, but I’ve come to believe forgiveness only benefits the one doing the forgiving…and only then if an unresolved issue is eating away at his core. I’m passed all that. I realize people are what they are and they won’t change unless they want to. In my opinion, life is best lived free of anyone who brings chaos, negativity, or meanness into it. I am at peace with this. I’ve had almost 72 great years of mostly good living by simply walking away from offensive people. There are lots of people who accept you without having to fight for those who don’t.   
I have not offered advice to anyone yet, but I’m going to now.
First, you don’t have to wait until the last week. In my case, I’m strong enough to do almost anything I want now, but that might not be the case for others. Therefore, I suggest young people work like crazy, save like there’s no tomorrow, and quit working as soon as they are sure they have enough for the future. Three years after my last heart operation, I retired for the last time. I’ve had 13 years of carefree living since that time. The only reason for working hard is to quit work as soon as possible.
Second, based on my observations, the best way to succeed in life is to do so in total love and commitment. This is important. When two people work together toward a common goal, and both are fully involved, they can move mountains. Only rarely can one member of a team reach a comfortable end game alone. Both must be fully committed. Both must work like the devil himself is riding their back. Time and again I have seen young and older people who are totally in love work toward and achieve a beautiful ending.
And that’s it, my secrets to a life in just a couple of sentences. I wish each and every one of you success in your life. I hope that all your dreams come true.
Thanks for reading,

James L. Hatch

By the way, if you leave a comment…and I respond…you’ll know I’m still kicking.          


Tina Donahue said...

Wow - this is pure awful, James. Didn't know you were having health issues. What can I say except I hope you respond (survive). Damn.

jean hart stewart said...

A wonderful column anyone would benefit by reading. God Bless!!!!!!

James L. Hatch said...

Written September 9, 2015

Although I don’t recommend the trip I just took through “Mitral Valve Land” as elective surgery, I can now tell you a little about it … and Baylor Scott & White Heart Hospital in Plano as well. Tomorrow, we will return to Temple. I feel stronger; however, a period of three month of physical therapy will follow to enable the heart muscle to recover. I also need time to build up my general physical condition. When a heart fails slowly, the loss of stamina and strength is incremental. One can easily attribute decreasing strength to getting older. Then, when the valve fails completely, fluid collects throughout the body, including the lungs.
When that happened, I couldn’t breathe. Even brushing my teeth was exhausting. Although we were oblivious to the symptoms that were killing me, we were lucky the doctors and PAs at the Temple Baylor Scott & White recognized the symptoms as quickly as they did. We called our Temple Cardiologist’s nurse on the morning of August 18th. She told us we should see our GP and get an immediate X-Ray. Our GP was fully scheduled, but we were allowed to see a PA named Sean Wilson. We were his last patient at the end of the day. After listening to my heart, he called in Dr. Fasolino, and in minutes, Dr. Fasolino looked up to tell us my heart had failed. We were stunned because I was still able to move around. He ordered a X-Ray series, and scheduled a 19 August emergency appointment with Dr. Lawrence, my cardiologist. He also provided medicine to get the fluid out of my lungs, something called Lasix.
The next day, Dr. Lawrence confirmed my heart had failed. He scheduled me into the “Cath Lab”, where diagnostic imaging equipment is used to visualize the arteries and chambers of the heart. He also ordered a TEE for the following day. An echocardiogram (echo) uses high-frequency sound waves to produce a graphic outline of the heart's movement. A transesophageal echo (TEE) is an echo test in which the ultrasound transducer, positioned on an endoscope, is guided down the patient's throat into the esophagus. An endoscope is a long, thin, flexible instrument that is about ½ inch in diameter. The TEE provides a close look at the heart's valves and chambers, without interference from the ribs or lungs.
Dr. Lawrence told us Temple S&W did not have a valve repair specialist, and that we should go to the Baylor Plano Heart Hospital for treatment. He scheduled a meeting with Dr. Smith, the leading mitral valve specialist in Texas, for August 25th. Dr. Smith only sees patients on Tuesday. He performs surgery the other days of the week. We left for Dallas, and our X-Ray, Cath, and TEE imagery went by Fed-Ex. Those vital images were nearly lost. Meredith and I recovered them from a wayward Fed-Ex truck at 9 p.m. on August 24th … and hand-delivered them to Dr. Smith’s office early the next morning. Dr. Smith had reviewed the images by the time we saw him. He confirmed my heart had failed, and scheduled a CTA (computed tomography angiography) for 1 September. CTA is typically used to examine blood vessels in the brain, neck, abdomen and chest.
The Baylor Scott & White Heart Hospital in Plano is unlike any hospital I’ve ever been to. Meredith and I were greeted by a pre-op staff that, like clockwork, walked us through a maze of blood tests, more X-Rays, and the CTA. We also had a short consult with Dr. Smith, where I learned he would NOT replace my valve unless he had to, and even then, he would NOT use the Saint Jude mechanical valve I expected. If he had to replace my valve, Dr. Smith said he would use a tissue valve. Tissue valves are made with tissues from porcine (pig) heart valves or bovine (cow) cardiac tissue because they function like human heart valves. I note that the selection of a “pig valve” had nothing to do with my personality, but everything to do with the fact that mechanical valves are created from man-made materials and lifetime therapy with an anticoagulant is needed when mechanical valves are used.

James L. Hatch said...

We reported for Surgery at 5:30 a.m. on September 3, and I soon discovered the benefits of 16 years of medical heart valve repair progress. Surgeons no longer break your sternum … unless they have to. Instead, they attach you to the heart/lung machine through arteries in the groin area, make a one-inch cut in your right armpit, spread the ribs without breaking them, and perform the entire operation robotically. A small tube through which instruments are passed is inserted through the one-inch slit. The tube is placed next to the heart, and the surgeon then cuts a small incision through the heart muscle. Once the tube is inside the heart, the surgeon uses micro-cameras to assess the situation with the valve.
In my case, the old mitral valve repair had to be completely removed. A new valve made from my own existing valve material was constructed higher up in the atrium. Initially, the surgeon thought I’d also need atrial oblation to steady my A-Fib, but the operation took so much time he opted to pass on that just to get blood flowing through the heart again. I was out of surgery in about six hours.
I was sore when I woke up, but the biggest problem was the breathing tube. Since I couldn’t talk, I wrote a few notes to Meredith on a clipboard:

“I need water” (an odd thing to ask, since I had a tube in my throat – I must have been just waking up).
“I’m naked and afraid”
“I’ve fallen and can’t get up”
“Very sleepy. I feel sick”
“I’m going to barf – tell them to remove the tube!” (they didn’t and I did)
“It will happen again. My stomach is sick.”
“Lots of stomach mucus churning here. They’ve got to get this thing out.” (they didn’t and I erupted again)
“I told them it would happen. I still feel terrible.”
“If they don’t take this thing out, I will make an even bigger mess.”

By the time the tube was removed, everything was nasty and my wounds ached from projectile contractions. As I recall, the breathing tube was one of the bigger problems 16 years ago, too. That time I woke up during the operation. Before I could grope for the tube, additional anesthesia swept me away amid shouts from the surgeons.
After the tube came out, I felt much better. I could swallow with difficulty and utter a few whispered words. My throat was raw. Recovery began. I am still amazed how quickly my body bounced back. I walked the halls around the nurse’s station the day after surgery. My appetite returned, although the bland, salt-free food tamped that down without additional medicine. I needed a few pain pills, but nothing narcotic (those pills made me nauseous). Breathing exercises began. I seemed to get my strength back in just two days.
I soon learned a new definition of pain—or maybe the definition I learned from Cleveland Clinic 16 years ago was simply reinforced. Yesterday, the Physician’s Assistant on duty removed the last drain tube from my heart. The tube had been lying against my right lung and was causing breathing issues. When the PA pulled it out, it was like being hit in the heart with a sledge. On the upside, I could breathe better by late afternoon and was released from the hospital by early evening. The tears had stopped by then, too.
Except for the encounter with the PA above, I was surprised at how short and painless my hospital stay was. I had surgery on Sep 3rd and was released on the 8th. In the past, that would have been impossible. Since the hospital also provided recent “on demand” movies, I also got caught up on a bunch of flicks I’ve wanted to see. Unfortunately, they did not have “Jupiter Rising.” Guess I’ll have to get that one from Red Box.

James L. Hatch said...

At the Baylor Heart Hospital, every patient gets a private room that is outfitted like a Recovery Room. Each floor is laid out around a nurse’s station, and a 7 X 24 staff tends to patients. The one thing I noted that I had not seen in other hospitals was that, to a person, the staff claimed they loved their jobs. It didn’t seem to matter if the person was in food service, janitorial, a NP, PA, RN, or Nursing Tech – they all loved what they were doing. I felt blessed to be there. I don’t know how medical care could be more complete or comfortable.
Each Recovery Room also provided a bed for family, but I asked Meredith to NOT stay over. The hospital staff works all the time – there is little rest except for naps between tests, PA and nurse visits, and rounds. If Meredith had not gone to Kathy’s house to sleep, she would have had no rest at all. Blood sugar testing, where they stab a finger every hour, also made it pretty hard to get rest, especially right after surgery. I cannot begin to tell you how much blood I gave, and I never knew exactly such how giving would change my day. More insulin? More anticoagulant? After one such collection, a nurse arrived with a “creamsicle drink” – a sure sign of low potassium.
Anyway, it’s over now except for the extended recovery. I look forward to getting my stamina and strength back. Thank you for your good wishes and prayers. It will be good to get home.

James L. Hatch

Tina Donahue said...

Relieved you made it through, James. I'm curious. You had this same operation 16 years ago? Or was that for something else? If it was for the valve, the doctors should have been monitoring you over the years for failure. Nothing last forever.

As far as CHF is concerned, I'm intimately familiar with the condition given that several in my family have had it. They were all in their late 80s, early 90s though. They also ate rich food throughout their lives.

Is your CHF a result of the valve problem? If so, is the valve problem a result of high blood pressure/cholesterol?

I've known people who've been pushed into CHF because of the wrong/inappropriate medication. I'm not a big fan of doctors. I'd rather eat sensibly (no junk food ever), no smoking, and a daily exercise regimen. Far cheaper than helping Big Pharma make a profit. It also puts me in charge of my health. I'm lucky to have good genetics. Family members generally make it to 90 even with bad habits. That said, taking care of my bod has make me feel immeasurably better.

Hope you're back on top soon.

James L. Hatch said...

Hi Tina:

Yes, it was the same operation that was done 16 years ago, and it has been monitored since that time. Unfortunately, the valve failed a month before my yearly exam was scheduled. My condition is congenital. My grandfather and mother both died from it, but the medical field now has ways to treat it ... and they get better all the time. In every other way, I am in excellent health, which is the reason I recover from these things so quickly. Once I get through the rehab, I expect to be water skiing again. Like you, I have great genetics (except for this tiny flaw), so I expect I will outlive the new repair and get to do this again when I'm in my 90's. There are no guarantees. What I can promise you is that I will live each day for the joy of the moment and have done so for years. Who knows, maybe I even have a few more Miss Havana books left in me?

Tina Donahue said...

Glad to hear the rest of your health is good, James. Be happy and you'll see many many more years. :)