It was just another day – I was getting ready to go to work and about to drive down one of the busiest stretches of motorway in Europe. I was sitting on the bed, stood up and felt like the top half of my body was detaching itself from the rest. Terror flooded me. I knew instantly that it was something catastrophic and I remember calling out, “I do not want to die!” as I staggered towards the bedroom door.
I remember those few steps and seconds, but curiously from behind and to the left of me, like a camera recording it. Then nothing.
About twenty minutes later (I have since calculated), for some reason, I regained consciousness. But there was total nothingness. I had no idea what I was, or who I was, where I was or what being ‘where’, was. But gradually my identity returned to me and I knew I needed help. I tried but initially could not remember what the number was for emergency services.
In London, because of its size and high density traffic, paramedics tour the city on motorbikes, so they can get to people ahead of an ambulance. So – “Can you get the front door open?” A simple, obvious but crucial question.
I have read many stories about misdiagnoses of aortic dissections and how the critical tool for diagnosis is a CT scan. Luckily for me, at Charing Cross Hospital in London, they scanned me straight away and found the problem, but its comparative rarity, or the lack of exposure of ER doctors to it, was evidenced when I heard the cardiologist explaining to the main medic on duty “Can you see it…it’s there…” Doctors learn on the job, how else can they?
Not much was explained to me, but I was told I had a problem and would need surgery and was going to be transferred to another hospital. I felt reasonably stable though I was probably sedated by this time.
I remember the feeling of a heavy weight on my chest and one moment, when a sudden pain went through my back that was so strong, that I’m pretty sure I levitated off the gurney. I could see it alarmed the doctors. By now my stepson had arrived at the hospital and as they prepped me ready for the transfer (catheter, etc.) a team formed at the end of the bed waiting – two doctors, two ambulance men. There seemed to be a long wait, apparently for an anesthetist. Suddenly the female doctor went ballistic, “What are we waiting for – we need to go now.” I heard this and, looking back now, it all felt surreal. A short time before, my everyday life was proceeding and now it seemed control of my life was slipping out of my hands. That things were obviously very serious, was confirmed when even more medical staff climbed into the ambulance, including the cardiologist. I would later learn that my aorta had leaked five out of the eight pints of blood into my body, which obviously causes massive blood pressure drop and the high possibility that the heart will stop with so little pressure and blood to pump. I felt fragile in the ambulance, weary. I was afraid but accepting at the same time, if that makes any sense. A phone was passed to me and I spoke with my wife who was in Spain at the time. She told me to hang in there for everyone.
On arrival at the Hammersmith Hospital, a surgeon waved a piece of paper at me. “You need to sign this, John.” I hesitated. “You don’t have a choice, John.” Then there were those few seconds as the anesthetist did his thing and I wondered if I would ever wake up.
The following day at around midday, I did.
I had suffered a Type A aortic dissection, which had been repaired with a Bentall root replacement (prosthesis). My aortic valve had been damaged and this was replaced with titanium. As everyone who has suffered this knows, this surgery is complex with the connective tissue of the aorta often compared to wet toilet paper – a nightmare to work with. I’m in awe of these surgeons who are artists with their skills in such repair. Because fitting a new valve is such a delicate and precise work – a pumping heart makes it very difficult, so the heart is stopped while this is stitched in and the patient kept alive on a bypass machine. I reflect back sometimes on those hours of which I know nothing and during which Mr. Punjabi and his team saved my life. Thank you, Sir, for your selfless work during the surgery and after, when you were so compassionate to me, and when you toured the wards and could tell I was in a lot of pain.
The next few days in intensive care were a blur. As is customary, it seems, two nurses on rotating shifts, sat on a raised platform with an array of machines and data and kind of ‘flew me.’ Oxygen was blasted into my lungs for hours to get my lung capacity up. Pain came intensely with a post-operative pleural effusion, but also in tasks that I had previously taken for granted, like breathing. I also had atrial fibrillation. But I grew stronger.
Not long after it seems the lower half of my aorta dissected from the prosthesis down to the bifurcation in the legs. This I’m told is too extensive to operate on – there are too many risks of blood loss, paralysis, and organ damage. Now that I actually have studied my aorta, I can see why, as I appreciate what a supply highway it is to all parts of the body – kidneys, liver, etc. This condition is managed defensively by blood pressure medication and beta-blockers, with the aim of reducing any spikes in pressure, which might stress the aorta and risk widening the dissection or worse, and to generally keep blood pressure in the 120/80 range. I’ve come to notice how blood pressure rises for me are very emotionally related. If I am worried about something it will rise. Even the anticipation of taking it can cause a big increase, (evidently the fear that it might be high), which then comes down dramatically as I take subsequent readings. How the mind and emotions can play with us!
This whole event has been life changing in so many ways. There are positives as well as negatives. Having been so close to death, I am more sanguine about its inevitability and aware of my own mortality. I try not to sweat the small stuff and I think I am more resilient to life’s knocks, They’ve come a plenty as the injury has caused an economic tsunami for my family. But it has also made me look at how I live my life and pushed me to take on projects that I always wanted to do.
I have now trained in counselling, specializing in hypnotherapy and in helping people who have suffered life changing events and struggle with the trauma of that (often labelled as PTSD – post traumatic stress disorder). Having been there myself, I understand the challenges, the rehabilitation, the worry, the loss of confidence, the fear of the future and daily life, to name but a few.