A story of triple by-pass


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Category: Health Care Date: 14 May 98

Heart attacks and heart disease is the leading cause of deaths in Trinidad and Tobago. But surgery can give people with heart disease a new lease on life. So can a way of life. The following is a first-person account with a man who has had open-heart surgery, and is based on an interview. Identity withheld.


“I am 58 years old. A year ago, when a friend of mine faced heavy bills after a stint in a nursing home, I decided to increase my medical insurance. While I was doing the stress test the doctor asked me if I felt any pain. I said ‘no’. He asked me if I could go faster. And when I did, he asked me to stop immediately. The indicators were saying my heart was starved for blood.


I did further tests, including an angiogram, which is a simple surgical procedure which enables doctors to get pictures of your heart. I had three blockages, one 90 percent and two 70-percentage blockages. There was a chance that a blood clot could get stuck in one of these blocked arteries, blocking oxygen. And once your cells are starved for oxygen, they die, then you die. I had silent heart disease, which means that although three arteries were severely blocked, I never felt any warning signs. But it explained why I would get tired after playing golf, was out of breath when I ran, or could not hold a note when singing.

I had three options:

1. Leave it as it is and lead a lifestyle more suited to an invalid.

2. Take drugs and hope for the best.

3. Surgery to clear up the blockage entirely, but there was a slim chance that I could die.


I saw three consultants and the first question they asked me was, ‘Do you smoke?’ Apparently smokers are always in a high-risk category. Surgery is always your decision but a senior cardiologist said if he was me, he would go for it. He said I was a good candidate for surgery because I had no other complications. I don’t smoke, or suffer from diabetes, or hypertension, and have never actually had a heart attack.


For the past 20 years I lived on a diet high in fibre and fruit, and low in red meats and fatty oils. I have always walked a lot. As a result my risk factor was only two percent. But since I was having preventive surgery I would be taking a chance with my life without having had a heart attack. In other words, there was only a two percent chance I would die during or after surgery. I soon discovered that although my risk was low, the costs would be high.

Open-heart surgery at Mount Hope Medical Centre would cost me TT$90,000. The cost of surgery in the States worked out to about TT$120,000. I discovered that open-heart surgery is big business in the US. The clinics I rang quoted anything from US$21,000 to US$36,000. Eventually I decided to have my surgery done in the US at a cost of TT$120,000, at the Miami Heart Institute, where there was a special offer for West Indian people.


When I got there I remember asking the surgeon, a Dr Ling, a Trinidadian, how many operations he had performed, and he told me 10,000. I preferred to have surgery done in a place where it is done routinely. I felt safer that way. When I got there, out of the 24 beds, 18 were occupied. I was told a curious fact. For some reason, in winter, when people return from cruises the occupancy is 100 percent. Many of them have to be airlifted into the institute.


Before I went up I liaised with the cardiologists there, and faxed up all my medical reports. I was scheduled to have heart surgery within two days of arrival. I checked in 12 hours before surgery. I was given a light meal and not allowed any aspirin since it can thin the blood and increase bleeding during surgery.


During the waiting period I told myself, ‘My risk of not making it is only two percent. Let the doctors do the work and I will use the power of my mind, positive thinking and prayer to do the rest.’ My wife was a rock of support. She never had any doubt I would come through safely.


I was not scared until I was told, ‘Good luck, say your prayers,’ by at least eight people while I was being prepared - the attendant who wheeled me in, the person who shaved my chest, nurses, interns, doctors. The last thing I remembered was a group of people in green coats silently saying prayers around me. I didn’t have time to be scared then because the anaesthetic took over. I was knocked out a second later.


I had three by-passes. They cut my breastplate down the middle, pulled it apart and held it open to access the heart. The meaning of by-pass is using new arteries taken from other parts of the body to go around, literally bypassing the blocked ones, to provide a clear tube which allows blood to flow freely in and out of the heart. The blocked arteries are left as they are.


The blockage is usually an accumulation of cholesterol, which is partly acquired due to unhealthy habits such as eating fatty foods, being sedentary and smoking. It is also partly inherited. There is a history of heart disease in my family and I think I also ate too much butter when I was young. For the first two bypasses they took three mammary arteries that lead to the breast and attached it from an area where the blood was flowing to the area starved for blood. They took out some veins from my left leg and used that for the third bypass. I asked the cardiologist later, only half joking, if that meant I had 110 percent flow in and out of the heart, since the blocked arteries still had 10 percent flow but he said ‘No, it’s a 100 percent in, and 100 percent out.’


When I woke up I thought I was dead. I heard a voice saying, ‘Are you hearing me?’ but because I couldn’t work out whether I was in Heaven or hell, I stayed silent. Then I heard another voice, ‘Are you hearing me?’ I was hoping I was in Heaven but I couldn’t be sure so I remained quiet. Finally when I heard a voice saying, ‘I am your nurse, can you hear me?’ ... that’s how I knew I was alive. I nodded, and grunted because I couldn’t yet speak.


Throughout the entire procedure I felt no pain. Firstly I was given a very powerful Tylenol for the pain and then the anaesthesia did the rest during the operation. As part of the post-operative care I was attached to eight wires and monitored round the clock by three nurses in the intensive care unit for five days. I was forced to walk in a day. Patients regularly walked in a quadrangle for exercise in order to get the heart going.


One day I walked a little further on and I heard a shout. I was surprised to see a panicked attendant. According to his computer I was dead because I was out of range of the monitor and he got no heart rate from me. It sounds ridiculous but my major fear was the chest would open up and the stitch would open and everything would come apart. In fact, the stitches heal over the steel attached inside you when they close you up and there is no chance of this happening, but sometimes I still feel a pull. The heart takes nine days to heal; the stitches take three months.


I was back to normal in two-and-a-half months - working, playing golf without getting tired, walking, even jogging and dancing.  I am energetic but cautious. I lie down when I get tired, and avoid all stressful situations, be they within my family, the office or on the TV. I watch my diet and eat plenty of fruit and avoid fats. Every six months I have a blood test to ensure that my cholesterol is under control.

On recovering I asked the doctor about my health. He told me, ‘The problems could recur if you don’t take care. Without correct diet, exercise and stress management you will get blockages.’ I was lucky in that I had organised my finances to deal with such an eventuality. Ninety thousand dollars is a lot for anyone to pay for surgery, so many go without. Most of the people I know who have had surgery here are doing very well. But more surgery should be done here. It should be made more accessible and cost about half of what it is now.


I think there should also be an association of people who have had heart disease or surgery. A support group. The worst thing was not knowing what was happening. When I came to, all they said was ‘breathe slowly’.  My heart was going at 100 MPH and I thought I was going to collapse. I found out later that during surgery I was put on a heart and lung machine and the heart was kept low in order to make it easier for the surgeon to work. When everything is done they figure the heart can take over. But it felt like the heart was being jump-started and that was scary.


Every two weeks or so, I get very depressed. Medicine can’t explain it, but it tends to happen to people who have undergone surgery. It must help to talk to other people who are going through the same thing. My advice is this: Start young. Manage stress, exercise, eat healthy food and, very importantly, take out medical insurance. The sad thing is that most young people who get heart attacks in their 40s die one time - they never get a second chance. Smoking is a major factor in this.


My advice is if you need heart surgery, and can find the funds, go and do it. I know many people, even those with complications such as diabetes and hypertension, who look very well for it. They say the surgery and postoperative care at Mount Hope is top class. The best thing about heart surgery is you can wake up and no longer be scared for your life.”

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All Articles Copyright Ira Mathur