Heart attacks are like car crashes. They only happen to other people.
That’s what many (most?) of us kid ourselves into believing, anyhow.
On March 26 2011, I was laying comfortably in bed when I began to feel a dull, but powerful, ache behind my left shoulder blade.
I wasn’t particularly worried – I’d had similar spasms before. One evening, we were enjoying a meal at a friend’s house when I felt the same sensation. But this and other similarly transitory aches and pains in the same general areas hadn’t amounted to anything; not that I knew of.
However my wife, Liz, insisted on driving me to the local hospital emergency department where, despite my somewhat testy protestations that I was OK, that it was probably only heartburn, the admittance clerk took my blood pressure and temperature and, I was wheel-chaired to a curtained cubicle where a nurse expertly drew blood from my left arm.
Soon after, a young doctor pushed aside the curtains and told me I’d had not one, but two heart attacks which ultimately led to a quadruple coronary bypass and a second equally big operation to fix a “catastrophic” (in the words of one of my doctors) infection in my chest bone which’d been carefully split top to bottom to allow the surgical team to quite literally get their hands on my heart.
Heart attacks without even knowing it
So far, I’ve two heart attacks.
I didn’t end up writhing in agony on the floor, or anything like that. On a scale of 1 to 10, the pain was probably no more than 4 or 5. And I’d once watched a coronary bypass operation in which the heart of the patient, a Portuguese workman, was so scarred he’d obviously had heart attacks in the past without even knowing it.
So it can be hard to tell.
I’ve been a professional writer for a long time, working on newspapers, magazines, blogs, and, briefly, television. But mainly in recent years, blogs. Then I had a couple of heart attacks and a quadruple coronary bypass during which I also suffered a stroke.
Heart attacks don’t necessarily lead to early death. People can, and do, live on long after. But there are invariably after effects. In my case, the most significant was the need for radical corrective surgery in the shape of a quadruple coronary bypass, where a piece of vein taken from my own body was grafted around the blocked blood supplies.
Two to four percent
An inherent risk of any open-heart procedure is the danger of a stroke occurring, and of an infection developing. With me, both events occurred, the latter necessitating a second open-heart operation.
The cardiac surgeon in whose care I was, told me the chances of a stroke happening to me were in the order of two to four percent. She didn’t say ‘negligible’ in so many words, but that was how I interpreted it. So I agreed to the surgery.
But during the operation, probably when she was working on my aortic artery to place the vein graft, a small speck of calcium hidden in my aortic arch fragmented, sending tiny pieces (multiple emboli) to both hemispheres of my brain, causing serious blockages in the blood supply.
This was a stroke and my brain crashed. But contrary to what’s still common belief among too many members of the medical profession, damaged brains can fix themselves.
Different strokes for different folks
‘Stroke,’ can mean different things to different patients; personality changes; partial paralysis; loss of vision and memory problems; and, other ‘deficits’ the euphemism for major or minor physical or mental changes.
Why ‘stroke’? Because in one fell stroke, your life changes irrevocably? People used to believe a stroke was an act of God.
Anyway, I’m sitting on the edge of the hospital bed, wondering what’s going on.
People bustle around me, asking questions, peering into my eyes, telling me to follow their finger, asking what day it is, what month, what year, do I know where you I am?
Do I even know who I am?
Something terrible has taken place.
And then there’s there’s the hemispatial neglect, a condition “in which, after damage to one [or both] hemispheres of the brain, a deficit in attention to, and awareness of, one side of space is observed,” says the Wikipedia, going on,
“It is defined by the inability for a person to process and perceive stimuli on one side of the body or environment that is not due to a lack of sensation. It’s “very commonly contra lateral to the damaged hemisphere, but instances of ipsilesional neglect (on the same side as the lesion) have been reported.”
What, where, why, how when?
That tiny speck of calcium hidden in my aortic arch fragmented, sending tiny pieces throughout my brain. It was a stroke. Brain damage, in so many words.
I was 69,w and totally anesthetised, having a piece of vein taken from my left leg grafted onto my aorta to bypass the blocked arteries which’d caused the heart attack in the first place.
At the time, I didn’t even know I’d had a stroke. That knowledge came long after. Nor do I remember anything leading up to the actual bypass surgery.
I vaguely recall being wheeled along a corridor door leading to the O/R, but that was it.
However, I knew exactly what was going to happen because in the 70s and 80s, as a freelance writer, I’d had a series on common surgical procedures published in the Toronto Star and Globe and Mail. The articles were meant to give readers an idea of operations they might one day experience themselves.
Wearing sterile scrubs and standing well back from the operating area, I’d watched the procedures as they were performed by the surgeons and their teams and the first had described – you guessed it – a coronary bypass.
“There are more than 50,000 strokes in Canada every year,” says the Canadian Stroke Network, going on. “Another 300,000 Canadians are living with the after-effects of stroke.”
But do we really need our brains?
John Lorber was a professor of paediatrics at the University of Sheffield in England. “He is also known for his writings on medical ethics, against use of intensive medication for severely handicapped infants, and against active euthanasia, says a post in the Wikipedia.
Then,in 1980, British science writer Roger Lewin published wrote, Is Your Brain Really Necessary? about Lorber ‘s work.
“He reported the case of a Sheffield University student with a measured IQ of 126 and math degree but who had “ ‘hardly any discernible brain matter at all since his cortex was extremely reduced by hydrocephalus’”, commonly known as water on the brain.
It was only when brain scanning technology became available in the mid 1970s that these cases of hydrocephalus patients with massively reduced brains came to light, says the Wikipedia.
The cyan cow’s udder
For five or six weeks, I was an in-patient undergoing neurological and physical rehabilitation at the Victoria General Hospital and every time I left my room I’d get hopelessly lost.
It reached the point where the nurses had to inflate a blue rubber surgical glove and tape it outside my door so I could find my room. It looked like a small, cyan cow’s udder But often, even that didn’t work and I’d roam the corridors like a phantom, trying to find my way.
As I write this, more than a year after my heart attacks, my brain still sometimes confuses my left with my right hand. But this has its advantages. In our home, I’m the designated washer-upper and it’s the perfect excuse for broken dishes.
Where did ‘I’ go? (Or what happened to ‘me’?)
In the meanwhile, a new person now occupies the mental space I’d thought of exclusively as ‘me,’ or I should say ‘us,’ ‘us’ the community of cells which make up our ‘selves.’
Because to all intents and purposes, the trio comprising Me, Myself and I died on the operating table.
‘We’ no longer exist. In every meaningful way, ‘I’ died during surgery. The person ‘I’ was is no more and can never be brought back.So who’s this this interloper who’s squatting in my brain?
So far, there’s no sign of me developing any extraordinary new skills, but I’m still hopeful 🙂
How are things today, and weeks and months after surgery?
Physically, they couldn’t be better. Once again, I’m able to help Liz with our embryo hot sauce business — lift cases, and so on. But I’m still struggling with difficulties relating directly to the stroke.
What, for example can be done about my hemispatial neglect, a condition “in which, after damage to one hemisphere of the brain, a deficit in attention to and awareness of one side of space is observed,” says the Wikipedia, going on,
“It is defined by the inability for a person to process and perceive stimuli on one side of the body or environment that is not due to a lack of sensation. It’s “very commonly contralateral to the damaged hemisphere, but instances of ipsilesional neglect (on the same side as the lesion) have been reported.”
[… ] “the parietal lobes are primarily involved in processing touch, muscle and joint information from the body and combining it with vision, hearing, and balance to give you a rich ‘multimedia’ understanding of your corporeal self and the world around it.
“Damage to the right parietal lobe commonly results in a phenomenon called hemispatial neglect: the patient loses awareness of the left half of visual space.”
Following the stroke which hit during my bypass, it’s a condition I now have, but it isn’t confined to the left, although that’s where/how it’s primarily manifested.
Sometimes my left arm or leg will feel disembodied and I have to look to see what’s going on, and there’s a general feeling — ‘sense’, really — of vacant space instead of actual sensation.
It’s very difficult to explain; it’s as if there’s a visual vacuum.
I can see perfectly well, but somehow, what I ‘see’ doesn’t register in my brain and I’m inclined to collide with things and people, particularly in crowded situations such as stores and marketplaces.
My wife, Liz, and I now own and operate a small Vancouver Island hot sauce business and during a recent trade show in Nanaimo, I met a young woman named Courtney who’d suffered a brain tumor at a young age which also produced hemispatial neglect.
I now occasionally use a collapsible white cane so people can see me coming:) Courtney uses one also, but in her case it’s to find her way around.
The condition can also be very unnerving in some circumstances such as when I’m walking between narrow spaces,with walls on both sides; ie an alleyway.
Right-sided spatial neglect is rare because there’s redundant processing of the right space by both the left and right cerebral hemispheres, whereas in most left-dominant brains, the left space is only processed by the right cerebral hemisphere.
In his book,The Telltale Brain, neuroscientist VS Ramachandran sums it up like this:
[… ] “the parietal lobes are primarily involved in processing touch, muscle and joint information from the body and combining it with vision, hearing, and balance to give you a rich ‘multimedia’ understanding of your corporeal self and the world around it. Damage to the right parietal lobe commonly results in a phenomenon called hemispatial neglect: the patient loses awareness of the left half of visual space.”
It’s a condition I now have, and sometimes my left arm or leg will feel disembodied and I have to look to see what’s going on because there’s a feeling of vacant space instead of actual sensation.
It’s not, however, all bad. One of the brain’s most amazing abilities is to be able to quite literally rewire, or reroute, parts of itself,
“Starting in the 1990s, [the] static view of the brain was steadily supplanted by a much more dynamic picture, Ramachandran states, going on,
[… “The brain’s so-called modules don’t do their jobs in isolation. There is a great deal of back-and-forth interaction between them, far more than previously suspected. Changes in the operation of one module ― say, from damage, or maturation, or from learning and life experience ― can lead to significant changes in the operations of many other modules to which it is connected.
“To a surprising extent, one module and even take over the functions of another. Far from being wired up to rigid, prenatal genetic blueprints, the brain’s wiring is highly malleable ― and not just in infants and young children, but throughout every adult lifetime.”
And what about my recurrent bouts of severe depression which inevitably follow major surgery of any kind,? Overall things are looking promising and I’m anticipating they’ll slowly but steadily Continue to smprove, especially if I use the technique I employed in an earlier life whilst giving up drugs, cigarettes and alcohol –
Pay attention to the minutes. The hours, days, months, years, will look after themselves and in the meanwhile, I’m counting my blessings, which are many.
Looking back I didn’t expect to be able to do the things I can do now; For example, I used to play guitar but for long time, I completely lost interest not only in it, but in music generally.
And if I really want to be thankful, I need to be thankful for my wife, Liz who somehow is unfailingly able to deal with my swings in mood and evil temper, not to mention my bad language.
Pre-stroke, I rarely swore unless I dropped something on my foot, or some such.
These days, effing and blinding is part of my everyday vocabulary. It’s almost like having acquired Tourette’s syndrome.
I’m slowly relearning guitar, and my enjoyment of music has returned in full. So, things could definitely be worse.
I could, for example, be dead 🙂
And of course, I’m blogging again and in the process, literally reprogramming my brain.