01/08/2024: Day -1
I was asked to come in for admission to St Bartholomew’s Hospital (Barts) in London before 4pm on the day before the surgery. I had duly followed instructions and stopped clopidogrel, a blood thinner, a week before. This was too make sure I didn’t bleed excessively during the surgery since the effect of cIopidogrel lasted a number of days. I had also washed with the antibacterial solution they had given me yesterday and again today. This was to reduce the risk of any infection after the surgery which would be disaster if it did occur.
My wife, Amnah, and daughter, Rahmah, drove me to the hospital. It would be a lie to say that I wasn’t a little nervous. However, more than that, I really was looking forward to getting the surgery over and done with. I just wanted to get on with my life that had been on hold ever since I was found to have significant blockage of three of my coronary arteries.
I had always tried to live a healthy life and practiced what I preached with my patients. I never smoked or drank alcohol, and enjoyed exercising my entire life. For most of my life as a doctor I had practised the low-fat diet that all doctors advised. You know the one; avoid fried and fatty food, eat white, lean meat and fish, and avoid red meat. Despite this healthy eating and exercising regularly, I found to my surprise that I gained weight all through my life. It was only when I did my own research into nutrition that I actually normalised my weight. However, it looked like the damage had already been done in the first 47 years of my life! Combine that with ‘bad’ South Asian genes and a stressful life as a GP and you have the recipe for blocked coronary arteries. Perhaps, if I hadn’t been exercising, and eating more healthily in the past 10 years, I would have had a heart attack or just keeled over one day, none the wiser.
As it was, I counted myself amongst the lucky ones. Just two months earlier, I heard the sad story of an Pakistani man in his 50s. He had just hiked up Snowdon with his children and was on his way down, when he just slumped down and died of a massive heart attack. It must have been such a shock to his family. Coronary heart disease is up to 50% greater in first-generation Asians such as me. I always thought it was unfair that some patients led an exemplary healthy life but still had high blood pressure and high cholesterol. Alternatively, I would see the overweight smokers and drinkers with completely normal readings. As always, medical studies told the averaged statistics of thousands of patients but not those on an individual basis. To make matters worse, studies were mostly done on Caucasians and did not necessarily translate well to other ethnic groups. Over the years, I had done my best to practice more personalised medicine tailored to the individual patient rather than apply a study’s findings.
We arrived at Barts just before 4pm and I checked myself in to ward 4A. I was first met by my cardiac surgeon who again went over the procedure with me. There was a small change to what he had planned. I was due to have at triple bypass composed of one artery and 2 veins. The vein would be taken from my leg and split into two. Instead the cardiac surgeon told me that I was going to have 2 arterial grafts and one vein since I was a relatively young patient. The second artery, the radial artery, would be harvested from the my left forearm. I was really pleased about that since arterial grafts lasted on average longer than venous grafts which became blocked sooner.
Soon afterwards, the cardiac surgery registrar came to get consent for the procedure. She told me of all the risks involved so that she could get informed consent. That included a 1-2% risk of stroke and death. That’s never great to hear but, put into context, it’s much smaller than the risk of me dropping dead of a heart attack with my coronary arteries in the state they were in. I readily signed the consent form.
The registrar told me that I was on the enhanced recovery pathway. Since I was relatively young for such surgery and generally fit, I would be mobilised more quickly postoperatively and discharged more quickly. Bypass patients typically spent 5-7 days in hospital but I would be discharged on day 4 if all went well.
In order to prepare me for the enhanced recovery, a nurse gave me a sickly sweet energy drink to take that night and I would have another at 6am the following morning.
The surgery was due the following afternoon. My family would not be able to see me until afterwards in ICU that evening so I said my goodbyes and started to mentally prepare for the day ahead.
02/08/2024: Day 0 - Surgery Day
I slept pretty well and woke the next morning around 6am as the ward started to wake up. I duly took the second energy drink and knew that would be the last to eat and drink until the surgery that afternoon.
One of the male nurses came over and handed me an electric shaver. I need to shave all the hair on my chest, my forearms where the artery was to be taken, and both inner legs where a vein was due to be harvested. I went to the bathroom and did the best I could. The last time I was that hairless was when I was 13! I called the nurse when I was finished and he came in and made some finishing touches.
I then needed to have another antibacterial shower and put on a theatre gown. I don’t know if you’ve ever seen or put on a theatre gown but it’s one of these contraptions that’s open and ties from behind. The chances of retaining any modesty are zero and I found myself gathering the material from behind to protect as much as I could.
Now it was just a matter of waiting. I called my wife and daughter a couple of times to update them. Having the day free in London, they had decided to Oxford Street to do some shopping whilst I was in theatre. I encouraged the retail therapy.
That morning, waiting for surgery, I reflected upon my life but not in any nervous or morbid sense. I was in the hands of incredibly capable professionals and heart bypass surgery had been started before I was born and refined over decades. Probably one of the most major operations that one could have, the surgery was likely to go well. However, nothing is a hundred percent so there was always a tiny chance that something might go wrong.
I thought about my life and reflected that God had been incredibly kind to me. I had a successful career achieving much more than I thought I would. I had a loving wife and children who I could be proud of. I felt incredibly privileged to be a doctor and would never swap that with any other type of work. I got an immense sense of satisfaction trying my best to help my patients throughout my working life. My patients had taught me as much about medicine as I had ever learned from books and I continued to learn. I don’t remember much that I learned from medical school but one thing always stuck in my mind: ‘listen to your patient, he is telling you the diagnosis’; William Osler (1849–1919). I remember Dr Brunt, the Queen’s physician, telling us that in Aberdeen Royal Infirmary and had taken it to heart. In modern times, one of patients’ chief complaints about doctors was that they didn’t listen to them. I hoped I would never be one of these doctors. Yes, I had lived a good life and, I thought, if it ended today then I wouldn’t have any complaints.
The waiting for surgery lasted longer than I thought. Finally at 2.30pm a lady came to collect me for theatre. Great, I thought, the time has come. The last time I had a general anaesthetic was when I was 10-years-old. I broke my wrist after falling from a bike, and had to have manipulation under anaesthesia. I can remember the anaesthetist asking me to count back from 10 whilst he injected the anaesthetic. I think I got to 7 and then woke up after the procedure feeling a little groggy. I knew it was likely to be the same experience again, only this time with bigger surgery between me being put to sleep and being woken up. In between, I would be none the wiser!
After checking that I was the correct patient, the lady walked me to the theatre anaesthesia room. Inside were two anaesthetists who did their best to put me at ease. One of them told me that I was lucky that I was being operated on by this particular surgeon as he was one of the best in the hospital. The other anaesthetist had an Irish accent. He told me step by step what he was doing to me. At one stage, he told me that he was cleaning my forehead with an alcohol wipe so that he could attach an electrode. I said that was fine as long as he wasn’t drinking the alcohol. At that, he quipped that he did like to have a drink before work just to steady his nerves. I chuckled and told him that I had an Irish aunt. When her family came over they did like their Guinness and karaoke!
One anaesthetist injected me with something and the other placed a mask over my face. Within a few seconds I lost consciousness.
I woke that night with a severe pain in the centre of my chest. Part of the surgery was to saw my breast bone in half and pull it apart so that my heart could be operated on. At the moment, that’s all I could feel. The ICU nurse asked me how much pain I had and I told him that it was 10/10. He put the patient-controlled-analgesia button in my hand and told me to press it until the pain resolved. It did resolve completely after 3-4 presses of the button and took less than 30 seconds. Amazing, the wonders of modern painkillers. I was vaguely aware that the wife and daughter were with me but I was still heavily under the influence of anaesthesia and didn’t have much awareness. I was just relieved that I had no further pain.
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