Returning to Dartmouth

The space in the helicopter was limited, but I didn't notice as they slid the stretcher into the enclosed area and crawled in around me. The Ativan had kicked in and I felt safe in the hands of the emergency team that was transporting me. Why I had previously begged not to return to Dartmouth, I'm unsure of. I'm guessing I just did not have enough oxygen in my brain to make a sound decision. Obviously I was needing to return to the better hospital, with my own surgeon who knows my case and can save my life, and better care facilities. I wouldn't willing suggest staying at the local run down hospital's emergency department with staff that was untrained in severe cardiac complications, like the effusion and cardiac tamponade I was experiencing. Cardiac tamponade is a complication from open heart surgery that occurs from an excessive build up of fluid on the heart to a point where a chamber collapses from the pressure and is no longer pushing oxygenated blood through the body. It is a serious and deadly condition, not commonly reached in post op patients. I was young for an open heart surgery to happen in the first place, but the complication of the fluid build up in the pericardial sac around the heart is something that can happen to anyone. The concern is if it is internal bleeding and blood is building up, instead of fluid from inflammation, than there may be more serious problems. Either way the fluid must be drained off of the heart to relieve pressure so it can beat normally. A small amount of fluid, under 50 ml, is naturally lubricating the pericardial sac at all times with the body reabsorbing excess constantly. Any more than that affects the hearts natural function, and this is when a special procedure needs to be performed. Pericardiocentesis is a procedure where the fluid is drained off of the heart. It can be performed in trauma cases with a large needle inserted near the bottom of the breastbone, or in a Cathlab procedure where a drainage tube is placed. This is what I woke up to in the emergency room, and thankfully was postponed until my arrival at Dartmouth. The DHART (Dartmouth Hitchcock Advance Response Team) guys were prepared to perform this emergency drainage procedure if my condition worsened during the flight.

Once I was on board and the helicopter took off I was stable enough to twist and look out the window. I saw the lights from the city drifting farther away as we rose in the sky and noticed the sun had set sometime between me rolling out of the hospital and boarding my first helicopter ride. I also saw the frozen lake beneath, and stars twinkling through a clear windy space. The ride was rough but lasted less than twenty minutes, and I managed to fall asleep for the last fifteen minutes. I was happy that they moved me quickly instead of a bumpy two hour ride by ambulance in an unstable position. The air felt like a cool promise upon arrival back to Dartmouth, as they pushed me across pavement to the hospital I had departed days earlier. I knew I was in safe hands, and that my mother was on her way. The first new face I saw was that of my confident surgeon who grabbed my hand and reassured me that I was in his care now and I would be alright. I remember thinking 'I feel terrible, he will fix me though.' He stayed by my side the entire time, as they ran new tests due to LRGH not sending along proper records. I was poked and prodded a million times that evening, becoming used to the abuse on my body. I knew they were just doing their job and I did not complain. At one point I made sure that my blue spa socks, gifted to me the day before by a close friend, were removed from my feet and put in a personal belongings bag. I did not want to lose something so significant to me after one had already fallen off and I begged for it to be found while settling into the trauma room in Dartmouth's ER. Soon after, the DHART team disappeared as swiftly as they had swooped in to rescue me, and I never saw them again. New nurses took over my vitals and making me comfortable as Dr. Discipio decided what the next step would be. I told him to make the decision for me, because I could not think clearly enough to decide what I wanted. He gave me an option, we could try for a Pericardiocentesis in the Cathlab with a doctor that had to be called in to place the tube and Discipio would watch, or we could go to the operating room where my doctor would do his own procedure, of what I'm unsure, and they would sedate me properly. The doctor was called in and an emergency Pericardiocentesis procedure was performed before my mother even reached the hospital, while I lay awake through the entire thing.

The first step was using topical anesthetic around the ribs in the left 5th and 6th intercostal space. The area was painful to numb and I whimpered as the needles dug through my bones. Then a large needle was inserted at an angle into my torso, and I could feel the puncture like a balloon popping as it pierced through the pericardial sac. All was watched with ultrasound and X-Ray equipment to avoid puncturing the lungs or further complications. The needle was retracted leaving a white narrow tube in place that was maneuvered with a metal wire for better positioning. I felt pain in my shoulder blade, typical of having a tube between your heart and it's protecting layer. Once in place they used large 100 cc (or ml) syringes to start pulling fluid off of the heart. They got through 700 ml of fluid and began to slow down, wanting to leave a little fluid to naturally drain with the tube left in place, avoiding another painful complication called Pericarditis where there isn't enough fluid creating further pain. The fluid was tested on a table to my left to make sure it was not bloody or infection filled. It was neat to think the twenty people bustling around me were doing their little jobs so efficiently and quickly and yet so late at night. They were all busy with their tasks at hand and to my left and right were the two most experienced in the room, making sure the job was done right. After the fluid was pulled off, they asked how I was doing. "I can breathe!" I exclaimed in relief. It's amazing how immediate the change was that I felt and I was instantly happy for the procedure no matter how painful it was. Still more work was performed as the drainage tube was covered with gauze and dressing, and I was prepared to be moved to the ICU. On the way out the door yet another angel in disguise took care of me, covering my feet in a warm blanket and making sure my personal belonging's bag followed me to ICU. He held my hand and kept the operating team from sliding me onto the bed hastily, keeping them from jarring me around in my discomfort. I knew I was in a position where I had the best possible care, and all the many angels that followed me along the way made the traumatic experience a little easier. I was cherished as a child, respected as an adult, honored as a lady, and protected as a patient in the care of the medical professionals at DHMC.

Post Op Day 8, The Crash

I got off the phone with my Cardiothoracic surgeon and sat quietly for a second letting the news sink in. I was just told the pathology results, that the port to treat my Lyme Disease was probably the cause of all the past two weeks of pain and suffering. The mass was a large clot, either from the tip of the port or possibly a blood clot disorder they would test for later on when I was recovered. My breath felt labored and I began to feel nauseas. I felt my heart pounding hard in my chest, and fumed about this news. Within minutes I began to decline. I scooted tenderly to the front of the chair, thinking I should go to the bathroom. I told my mother I needed some anti anxiety medicine, and thought I was having a slight panic attack. 'How dare I get myself so worked up over something so trivial', I thought to myself. By the time my mother walked to my room to grab the anti anxiety medicine, both of us thinking I was just upset, I worsened. I grabbed the first thing to throw up in, a cardboard box on the couch next to me, and hugged it to my chest, feeling myself breaking out in an immediate cold sweat. I became so dizzy and weak that I fell backwards into the chair, and turned white as a ghost. My mother returned with a confused look on her face. "What's wrong?" She said, seeing my condition diving fast. She felt the immense sweating and knew immediately this was not simple panic attack stuff. I barely managed to say "something is really wrong, call 911" as I felt myself slipping into the black. She grabbed the blood pressure cuff and the electric machine read 'error', unable to register a pressure as it dropped so severely low. I remember thinking, as people bustled around me, 'wow, I feel terrible. I'm sweating. There's no pain but I think I'm having a heart attack. I don't think the EMT's will make it in time. So, this is what it's like to die? It's happening pretty quickly, a minute ago I was fine.'

I don't remember a section of time as my breathing stopped, and my mother shook my hands to try and keep me with her. I don't remember staring blankly into midair in an unconscious stupor. The paramedic arrived as I was slowly coming to again, my oxygen reading at 60, temperature under 90 degrees. The blood pressure was so low that I was unable to get oxygen to my brain, and I was struggling to make eye contact or understand what was happening. My mother did not allow the rescue team to move me, as they reached for my arms. She protected my sternal incision by pushing them away and helping me move my own weight to the stretcher. Once I was settled on the stretcher I was not moved again except by sliding a sheet to and from surfaces. I begged them not to hurt my chest, still sensitive from a week before when I had the open heart surgery. The got me in the ambulance, placed an IV and began an EKG and all my vitals which were gradually settling back to safe levels. I was becoming more aware of my surroundings and discussed with the paramedic my condition, the syncopal episode, while on the drive to the hospital. She suspected septic shock, maybe from an internal infection. I was wheeled into the emergency room at LRGH and immediately seen by doctors and nurses and machines of different types. They quickly ran a few EKGs, seeing unnatural rhythms, and ran a chest X-Ray in the bed. The doctor got the portable ultrasound machine and placed it on my chest, as nurses bustled around me poking and prodding. I was vaguely aware of the violation of my body, where hands made themselves at home and eyes traveled my scars for signs of problems. My surgeon was phoned about my condition, and a decision was made to transport me by helicopter to Dartmouth as the quickest option. I was no longer in a stable condition, within fifteen minutes I had declined yet again to unhealthy vitals, extreme nausea, and the doctors discussed my echo pictures over me while I wavered in and out of attention. My mother and father were there with me in the trauma room, and a herd awaited in the ER waiting room from the news of my condition. I was listed in critical condition, but my grandparents and boyfriend got to come in one at a time and pray with me and say hello briefly. I don't even remember the faces coming and going, words that were said, things that were done. Apparently I even told my mother I needed to say goodbye 'one last time' and 'don't let them bring me back to Dartmouth, it's so far away'. I knew my situation was serious, but I had no idea how serious. Recounting the events later, I was informed that I had leaned forward to throw up and passed out cold again (every time I sat up my blood pressure dropped to the point of loss of consciousness, which the ER did not pick up on). The doctor yelled for beta-dine, and my mother and boyfriend were rushed out of the area along with another nearby patient. On their way out, they heard the two doctors peering over the ultrasound picture discussing a collapsed right ventricle (known as cardiac tamponade) and fluid on the heart (pericardial effusion). I pulled out of the black abyss slowly, and cried 'where am I?' before looking down. I saw my orange stomach and the young doctor hovering a large needle only three inches above my sensitive skin. Immediately panic set in and I screamed and flailed. "You are not touching me with that, I'm awake now, don't touch me, please use Lidocaine," I cried loud enough for the entire hospital to hear. Someone dug in my left arm for an IV access and as my blood pressure rose. Right at that moment the DHART helicopter response team strolled in to see the chaos. They cleared out the room, gave up on the second IV possibility, and demanded Lidocaine for my comfort in case of a future emergency pericardial drain procedure. Ativan was administered to calm me before the flight, and my condition was stabilized. These few men took control of the situation, kept my needs met, and saved me from a traumatizing situation. I stil view them as angels as I recollect the face of the head paramedic in my mind. I will never forget his first action, where he grabbed my hand and announced with confident 'I am Kevin, I am going to take good care of you, what can I do to make you more comfortable?' As I was rolled out, half way aware of what was occurring, I got to say goodbye to the lineup of family that had formed. My parents first, then my grandparents, Robbie with his unsure look of concern, and an aunt and uncle with their children, all yelling well wishes and patting my arm as I passed, on my way to a small green helicopter waiting to escort me in style.