‘This wasn’t happening to someone else, it was MY heart’

I COULD tell he was about to say something important.

As he removed the stethoscope from my chest and turned to wash his hands, I sensed he was considering how to break the news.

The cardiologist came back to his desk, looked again at the scan results on his computer and said calmly, ‘I’m going to recommend you for assessment for open-heart surgery.’

He seemed to pronounce the words deliberately. Open. Heart. Surgery. As if to ensure that the message was clear: it meant cutting open my heart.

That was the start of an extraordinary journey.

I have to admit I wasn’t really surprised. Nine years earlier I’d had an unexpected heart attack, which required an urgent trip to Southampton General and the insertion of a stent into my right coronary artery.

A stent is a small hollow tube inserted into a narrowed artery to keep it open; there are probably more people walking around Guernsey with those than you imagine.

At that time I’d been told my aortic valve was narrowing, or ‘stenosed’ in the jargon, and since then I’d had regular check-ups to confirm that the stent was working, but also to monitor the aortic valve.

From my knowledge of anatomy I knew that the aortic valve was important. It allows blood from the heart to pass into the main artery which supplies the whole body. If it becomes too narrowed then it can lead to heart failure.

If it becomes blocked, a medical term to describe the outcome is ‘fatal’.

Despite my interest in physiology and medical matters, the thought of open-heart surgery was still a little daunting. After all, this wasn’t happening to someone else, it was MY heart. And I was quite attached to it.

The cardiologist assured me that while the operation was classed as major heart surgery, it was nevertheless routine. He told me he’d see me again after the op.

That last bit seemed reassuring.

I asked about the timescale, and he expected the procedure to be performed in about 12 weeks’ time, so at least I could comfort myself that it wasn’t an emergency. It gave me time to prepare myself, and to finish any domestic tasks that were awaiting completion.

I was a little surprised, therefore, to receive a call just 10 days later from Southampton General asking if I could attend for an assessment.

The caller sent me a confirmatory email and advised me to forward it to the States Insurance travel department, as they arrange flights to Southampton General for local patients.

I admit to a little scepticism expecting an answer from a States department on a Friday afternoon, but credit where it’s due, a charming voice answered the phone, I forwarded the email, and 30 minutes later she phoned back to confirm flights were booked and so was a taxi from Southampton Airport to the hospital.

I was impressed.

On the due date, I attended Southampton General with the list of tests I was to undergo: a blood test, a chest x-ray, a lung function test, ECG, and then a consultation with the surgeon, each spaced about half an hour apart.

Those of you familiar with Southampton General will know that it is a sprawling building spread over several levels, but it was fairly easy to follow the signs to each department on my list.

And without fail, as I found and entered each department, they said they were expecting me.

If my name had been Bond, it would have been quite unnerving.

Every time I was asked to confirm the same details: my name and date of birth. I rather hoped some would query the year of my birth as I looked so young, but their professionalism obviously prevented them doing such a thing.

Each time I gave my name I was put at the front of the queue, although there were some patients there before me. When I commented on their efficiency in being ready for me, a radiographer explained that they knew patients from Guernsey would have a return flight to catch, so they planned to get all the tests done on time.

I was again impressed.

The only exception was the last appointment, with the consultant surgeon, but even he was only 10 minutes late and, to be fair, in medical circles that’s close to a record.

The surgeon said he agreed with the cardiologist in Guernsey that an operation to replace my aortic valve was necessary. He carefully outlined the procedure he would perform and how long it would take, adding that the new valve would be made from bovine tissue.

I’d heard of pigs’ valves being used, but bovine? Isn’t that cow?

I resisted the temptation to ask if I could specify a Guernsey.

He explained there were risks involved, as with any surgery, but of course the risk of not doing anything was considerably higher. He again added that although it was a major operation, it was a routine one.

He then introduced me to a cardiac nurse who took me into another room and explained in detail the admission procedure before the operation, and the arrangements for my recovery afterwards, saying I could expect to be back in Guernsey about a week after the operation.

I would be restricted in the physical activities I could do for several weeks after the operation; I would not be able to drive, or cycle or swim, but the cardiac rehabilitation people in Guernsey would take care of my progress back on the island. Full recovery could take several months, she said, handing over leaflets about the whole process.

Her detailed explanation of how everything would proceed was very reassuring and indicated that this was indeed routine to them. They were still going to cut open my heart, but were very confident about the outcome and the recovery plan. They’d obviously done this before.

I returned to Guernsey much more informed about what would happen and started planning the things I needed to do before my activities were restricted following the operation.

My list of jobs to be completed was rather ambitious, but then it always is, even without any medical imperative, and I had to modify it when I received a surprise call from Southampton three weeks later asking if I could go for my operation in a fortnight’s time.

I said I’d check my diary, but as the words left my lips my brain interceded: what was I saying? I was being offered a major heart operation within a few weeks which could end up saving my life.

OK, I was sure I’d be able to find a window.

My friends and family all said it was good news; it gave me less time to worry about it, and a recovery earlier than expected.

Once again a phone call to the States Insurance arranged all my travel, including the procedure for booking flights back once I was able to return to Guernsey.

The consultant had told me he might perform the operation in the Spire hospital next to Southampton General, and this was confirmed, and so two weeks later I dutifully arrived outside the hospital entrance.

I stopped for a second to look around at the flowers and greenery outside and breathe my last gulp of fresh air before entering into an unknown future.

I recalled the last time I’d stopped to enjoy a similar moment of freedom. It was before stepping into the church on my wedding day.

I was welcomed and admitted to a ward by some charming nurses, and that evening the surgeon came to see me and explain again the procedure he would perform the next morning.

He was going to cut open my breastbone and through the underlying tissue to gain access to my heart. I would be attached to a heart lung machine to take over my circulation and breathing and then my heart would be stopped.

Once he’d inserted the new valve he would restart the heart, reclose my chest and, hey presto, done. I presume he would then go for a coffee.

A few minutes after his visit, he was followed by the anaesthetist, who again explained the procedure and described the anaesthetic preparation, although advising that I probably wouldn’t remember much about the latter.

I hoped she meant the former as well.

She told me that after the operation I would be moved to a critical care unit where they would check that the heart and other organs were working correctly before waking me up from the anaesthetic.

I would find myself connected to various tubes and monitors when I woke up and she explained what they all did in an extremely informative and reassuring way. .

The following morning some nurses came to administer a pre-med, and shortly afterwards I was taken on a trolley to the ante room just outside the theatre, where a pleasant nurse chatted to me while I waited for the anaesthetist to arrive.

I expected the anaesthetist to give me an injection and ask me to start counting down from 10 to one to see how fast I succumbed, but it wasn’t like that at all.

I was chatting to the nurse and the next minute I was in the critical care unit, with the promised tubes connected to various machines and a big dressing covering my chest. The operation was over, several hours ago.

I started to take in my surroundings rather like someone emerging from suspended animation after a long trip in space. Well, that’s what it was like in Red Dwarf, anyway.

I stayed in the critical care unit for some hours while observations were taken and recorded, and once the staff were happy with my recovery I was moved back to a ward.

Here, regular checks continued. Those familiar with post-operative recovery will know that frequent tests, together with the bleeping of machines that monitor heart rate and other functions, make restful sleep almost impossible.

Every two hours there were tablets to take, painkillers administered, oxygen levels and blood pressure checked and so on. The longest respite seemed to be at night, three hours in between a catheter being checked and an ECG taken at 5am.

Despite this at 7.30am the next day the surgeon arrived to check on me, and casually asked if I managed to get some sleep. I don’t think he was being ironic.

He told me the operation had been a textbook success, with everything going to plan. He didn’t seem the least bit surprised.

He then explained that the nursing staff would monitor my kidney function, bowels, lung function, together with blood electrolyte balance and other factors, since these had all been affected by the surgery or the anaesthetic.

In addition, physiotherapists would be around later that day to show me exercises to assist my chest muscles and my breathing, since these also needed to recover from the operation. He explained my hoarse voice was simply the result of having tubes down my throat and would recover soon.

As it seemed every organ in my body was having a name-check, I felt obliged to query why he hadn’t mentioned the heart.

He smiled and without being sardonic replied, ‘No need. We’ve fixed that.’

Good answer, I thought.

When he left I thought about the little valve that he’d sewn into my heart. I was lying in bed with tubes attached and couldn’t get comfortable to read or sleep, so found myself performing a little mental arithmetic.

If my pulse rate was around 70 beats a minute, that meant that the new valve was opening and closing 70 times a minute. So with 60 minutes in an hour that would be 70 times 60, or 4,200 times an hour.

Rounding up the numbers in my head I reckoned for a 24-hour day I could approximate the sum to about 4,000 x 25.

That seemed a lot, so I did the sum mentally again to check and reached the same conclusion: in the 24 hours since the operation, that little valve in my heart, less than one inch across, had opened and closed about 100,000 times.

I was impressed.

As each day passed, and each 100,000 beats, the number of tests and observations decreased, as did the number of tubes. The physiotherapists had me walking a little further each day, until five days after the operation the doctor told me I could go home once they were satisfied that I could manage stairs and cope with the short flight back to Guernsey.

A well-practised system then swung into operation.

Two staff members in Southampton General act as Channel Islands liaison officers. Once they were notified that I was ready to go home they arranged the necessary paperwork, obtained written confirmation from the doctor that I was fit to fly, contacted the States Insurance, booked flights and a taxi to the airport, and passed all the information on to the ward nurses so they could prepare for my discharge.

A pharmacist came to give me medication to take home with me and explained how and when to take it, physiotherapists came to give me last-minute advice on exercises, and the nurses prepared for my discharge and gave me a copy of a letter which would be sent to my GP. They advised me to make an appointment with my GP for a week’s time so he could examine the wound on my chest and check my medication.

It seemed the ward nurses, pharmacists, physios, liaison officers, and even my GP, were all in the loop; that’s a lot of medical specialties co-ordinating to ensure my best treatment.

I was impressed.

The physios advised me that once home I should take it easy and not try to do too much too soon. Gentle exercise in the form of walking to rehabilitate the lungs, but no cycling or driving. I understood why when I found myself out of breath merely walking up stairs.

After a few days I felt able to go out, and found it surprisingly easy to navigate the bus routes, taking a ride so that I could get off at a stop and walk to a location for coffee as a form of exercise, before walking a little more after the refreshment and then catching a bus back home.

Southampton Hospital had given me painkillers to take as necessary, but I found any aches involved mainly the chest area when stretching my arms or pushing on something.

Not surprising when you think that the breastbone forms a main attachment for the chest and arm muscles, and they had cut the bone in half and then wired it together again.

The exception was coughing or sneezing. These involuntary lung spasms caused brief but agonising shooting pain in my chest. You know how difficult it is to suppress a cough or a sneeze, especially when you feel its arrival is imminent? It hurts even now to recall the experience.

I was comforted a little by a visit from a church member who had had open-heart surgery a year ago. He told me had suffered exactly the same symptoms but was now fine and was cycling over 100 miles a week.

I felt somehow reassured, albeit with no intention of trying to match the 100-mile target.

And before you ask, yes, we did compare scars. His was now almost imperceptible but had been as obvious as mine a year ago.

As instructed, eight days after returning to Guernsey I attended an appointment with my GP, taking a copy of the letter from Southampton in case he hadn’t yet received it.

He checked the wound on my chest, took my blood pressure and listened to my heart so he could hear the new valve. I didn’t ask if he could identify the breed.

He confirmed the medication the hospital had prescribed, told me everything was in order and reassured me that I’d slowly but surely return to normal activity.

I returned home and as I walked in the door the phone started ringing. It was the cardiology department at the PEH. Oh no, what had they discovered?

The caller said he was aware that I’d had an aortic valve replacement, they’d received all the details from Southampton, and he wanted to check that everything was OK.

I was obviously being followed.

If my name had been Bond, it would have been worrying.

It was, however, quite reassuring. He explained that he was a cardiac physiologist and asked if I had any questions or concerns.

He reassured me that the symptoms I described were absolutely normal, offered advice on exercise and recovery, and told me to phone if I had any queries.

He added that as part of the follow-up he’d be in touch again in four weeks’ time to introduce me to cardiac rehabilitation classes.

I was impressed.

Each day there was a slight improvement, less breathlessness going upstairs, a little less tiredness in my arms, and I was able to get off the bus a little earlier and walk further for my cup of coffee.

A few weeks later, as promised, the cardiology team phoned again, this time to invite me to join the cardiac rehabilitation programme.

There can often be a slight fear that having had a heart operation it is important not to place a strain on the heart. I had, after all, been told not to be too ambitious and to take it easy.

But the heart is, of course, a muscle. And the purpose of the programme is to encourage people to exercise that muscle, together with others, under controlled conditions, and to enable them to return to normal daily activity.

The programme is held at Beau Sejour, in a dedicated room away from public access. If you’ve been to the leisure centre you may have noticed the partially frosted glass door.

I was met there by the person who had phoned me from the PEH. He took me into what appeared to be a cross between a consulting room and a mini gymnasium, where a handful of people, all of whom had suffered heart problems, were gathered.

After an initial introduction he checked my medical details, took my blood pressure, oxygen levels and pulse rate, and explained that the aim was to show me how to strengthen my heart by exercising under supervision, gradually to improve my overall fitness to get back to normal life and reduce the chances of future problems.

The exercises started with simply walking, and then progressed as I became more confident, any breathlessness or aches and pains being monitored by the instructors as I proceeded.

Out of interest I asked what training the instructors had in dealing with heart patients. It transpired that one was a cardiac physiologist, one a cardiac physiotherapist, and one a cardiac nurse, all full-time staff who work in the cardiology department at the PEH.

That’s a considerable amount of expertise.

When I reported a slight pain in my shoulder, the physiotherapist was able to identify the muscle involved, explain how it was a result of the surgery, and give me some specific exercises to do at home to resolve the problem. In short I had a personal one-to-one consultation specifically aimed at my circumstances.

There were two sessions a week; each time my heart action was monitored and exercises modified to suit my personal needs, and as time went on I began to feel much more confident in my ability to perform everyday activities without causing any strain or damage to my heart or other organs.

There was almost a tinge of sadness when, six weeks later, the instructors told me that I was fit enough to leave the programme, and confirmed that I could go swimming or cycling, with the rather familiar advice by now to start slowly and give myself time to build up stamina.

They strongly advised me to keep up the exercises they had shown me, adding that I was not too old or infirm to consider joining a gym to maintain and improve my heart health and my fitness.

Drat.

To some this might come as an unwelcome observation, but in the past I had tried to stay reasonably active, and now I was recovering from open heart surgery I did not want to go backwards and potentially suffer more problems in the future.

I knew that I would struggle to motivate myself to do exercises at home. They would inevitably incorporate gradually less intense activity, and as time went on I knew rest periods would slowly morph into what others would call long coffee breaks.

I would be more likely to adhere to a routine in a gym, and here I found more co-ordination, for the gym at Beau Sejour operates a programme called Active Health, which encourages supervised low-resistance exercise for those who have medical conditions or who would benefit from regular gentle activity.

As part of this programme, the gym is accredited to provide Cardiac Rehabilitation Phase 4 for heart patients. Those who, like me, were now able to exercise independently, but who still might benefit from encouragement and support appropriate to post-operative recovery.

I decided that was a good option for me, and with my permission the head of the Active Health programme was able to review my progress from the rehabilitation classes, together with my medication, and compile an exercise programme for me, or approve those which I was doing myself.

It also meant the instructors could keep an eye on me to ensure I gained maximum benefit from my membership and help me gradually progress to full independence.

About this time I received an appointment from the cardiology department to attend for a heart scan, and the cardiologist told me that if the scan was satisfactory he wouldn’t need to do any more check-ups for about five years.

Reassuringly, I took that to mean he expected me to last at least another five years.

I made it part of my routine to go the gym twice or more a week, and gradually proved that my heart could cope with swimming, cycling and activities such as gardening.

I could even keep up with my grandchildren. Well, as much as I ever could.

Six months after my operation, I met a man who’d had a new aortic valve fitted two years ago. He told me he’d just returned from a cruise, had enjoyed snorkelling and kayaking on his holiday and had never felt better.

That was all the incentive I needed to book a Caribbean cruise myself, as a treat to celebrate my progress after such a major heart operation.

On the flight to my destination I thought about all that had happened to me since the day the cardiologist broke the news that I would need open-heart surgery.

And how so much coordination by so many people had contributed to a successful outcome after what had originally been a pretty scary prospect.

As I looked out of the aircraft window I contemplated another mental exercise to estimate the number of times that little aortic valve had opened and closed in the six months since I had become its host.

But to be honest, in the end I didn’t bother. I knew it would be a pretty incredible number.

And I knew I’d be impressed.