Cabbage Day [Updated]

So the other day my friend Leo got a call from his cardiologist confirming an appointment. As I’ve mentioned before (post 1, post 2), Leo and his father are staying with us while Leo recovers from heart problems and a stroke. We had set up an appointment with his cardiologist for last Friday in preparation for heart surgery, but according to the call he received, the appointment was not on the day I had in my calendar. I called the cardiologist to find out what was going on, and the office staff had no idea what I was talking about. They had the same date for the appointment that I did.

So maybe Leo misunderstood the message. He has aphasia from the stroke, so he has trouble communicating with people, and it didn’t help that the message was one of those robo-call appointment reminders, which left him unable to ask for clarification. This was really not a good way to communicate with a stroke victim.

Eventually, I figured out what was going on. This call was actually from his cardiac surgeon rather than his cardiologist. Apparently, the surgeon had visited him while he was in the hospital, and somebody had set up a followup appointment, and not bothered to tell us about it.

Actually, we’re pretty sure they told Leo about the appointment, but this would have been a few days after his stroke. I’ve mentioned that his mental abilities are improving every day. The corollary is that his mental abilities were much worse when all this started. He remembers very little that happened during that first week after the stroke.

(This sort of thing was a common occurrence when dealing with Leo’s healthcare providers. A few days after this call we got another call about a cardiology appointment we had never heard of. This time it turned out to be a cardiologist who saw him at the second hospital and wanted to do a followup. We agreed there was no reason to see two cardiologists and cancelled the second one.)

Anyway, since the cardiologist and the surgeon are located a few minutes apart but about 50 miles away from my home, we got the surgeon’s office to reschedule their appointment to the same day as the cardiology appointment we already had, with a tentative surgery date of the following Wednesday. However, when Friday came, the cardiologist’s office called to cancel the appointment and asked if we could reschedule for the following Monday or next Friday. Suppressing my annoyance at the scheduling issue and the fact that these people clearly do not talk to each other, I explained that our surgery date meant next Friday was too late, so we’d be there on Monday.

It was still a busy day. We met with the surgeon’s office nurse, and she asked us a lot of questions and explained the process to us. The whole staff seemed very efficient. Then we were off to the neighboring hospital for pre-operative lab tests and a chest X-ray. Before I even got the car started, however, we got a call from the surgeon’s office. After we had left, the surgeon decided he needed a CT scan of Leo’s head, and in the time it took us to walk out to the car, his staff had called the radiology department to set it up. All we needed to do was tell the receptionist.

That all went relatively quick, and with the afternoon off because of the cardiologist’s rescheduling, we decided to drive over to Leo’s house just to make sure everything was okay.

Leo is something of an amateur naturalist, and last year he killed off all the grass in his yard so he could replant it with wildflower seeds native to the Illinois prairie. When I last saw the place, the prairie flowers had grown in a few feet high and looked pretty thick, but when we got there on Friday afternoon, almost a month later, Leo’s yard had turned into a spectacular explosion of dozens of different types of plants towering over my head and teaming with tiny wildlife.

Leo also likes to feed the local critters — birds, deer, raccoons, skunks, cats, etc. — so he can take pictures of them, but it looked like the feed bags he keeps in his house were starting to attract bugs, so we dumped them out at the back of his property so the local fauna could chow down.

(In my neighborhood, uncontrolled plant growth and feeding wildlife would piss off my neighbors and probably get me cited and fined, but it’s amazing what you can get away with when you live in an unincorporated area far from the prying busybodies in town government.)

While we were there, we started Leo’s car and moved it a bit so the tires wouldn’t develop a flat spot. (I don’t know if that’s really still a thing with modern tires.) We also rebooted the home network, which was behaving a little weird, and tidied up a bit.

On Monday, I stayed home to work while my wife took Leo to the cardiologist’s office. While they were there, the surgeon’s office called to say they needed some kind of approval from his primary care doctor. After a bit of a pissing match between the two offices, Leo’s doctor managed to get them in late that afternoon, which pretty much killed the whole day.

On Tuesday night, Leo ate his last meal before surgery. He then took a shower using special soap. This morning we got up at 4am, and he took another shower with the same stuff. I guess the idea is to minimize the chance that the surgical team will pick up contamination from a non-sterilized part of Leo’s body.

We were ready early, so we left early, just in case we ran into unexpected delays during the drive. We didn’t, so we got to the hospital an hour ahead of time. Eventually they brought us into some kind of prep room where Leo changed out of his street clothes. The anesthesiologist visited. The surgeon visited. They explained what would happen. They started an IV. And then we sat around and both dozed off until they came to take him an hour and a half later.

I’m in the waiting room now, trying to keep calm and keep occupied.

Leo is having open-heart surgery. It’s a cardiac artery bypass graft, abbreviated to CABG, which all the cool kids apparently call “cabbage.” Basically, as I understand it, they will knock him out and then open up his chest and cut through his chest bones to get at his heart. Then they hook him up to a heart-lung bypass machine that oxygenates and circulates his blood. This allows them to stop his heart. With the heart immobile, the surgeon can splice grafts into the cardiac arteries using relatively unused blood vessels from Leo’s leg. He’ll try to add as many grafts as he can, to maximize blood flow to the heart muscle. When he’s done, they will restart Leo’s heart, wire his chest back together, and then close him up. He’ll recover in the ICU for a day or two, and then they’ll move him to a regular room

As you might guess, this is not a sure thing. The heart-lung bypass lines can come loose, or he can start bleeding where they’re connected, or the machine can cause his blood to form clots which will enter his blood stream. The surgeon could make a mistake. A blood vessel could tear. His heart might not restart. Leo could start bleeding internally after the surgery. And there’s always the risk of infection.

Leo’s surgeon is apparently one of the best. The hospital staff speaks highly of him. Leo’s doctor says he’s the guy she’d want if she was having the surgery. From what they’re saying about him, I get the feeling he’s the kind of surgeon from whom medical students learn how to behave in the operating room.

And yet… there’s a small chance — but not small enough to be negligible — that my friend Leo will die. I can’t really grasp that. I can’t imagine what it would mean to me if Leo were gone. What haunts me now is thought of making that hour-long drive home to tell Leo’s wonderful father that his son is dead.

Really, though, I’m mostly OK. The surgery will in all likelihood go just fine. It usually does. There aren’t a lot of complications in Leo’s case, and everybody seems real confident. So the odds of failure are probably pretty small. Less than 1-in-100. Maybe less than 1-in-1000. In one sense, that’s terrific. But it’s still probably hundreds or thousands of times greater risk of death than on an ordinary day.

Well, an ordinary day for an ordinary person. With Leo’s heart problems, he’d be very likely to die soon without the surgery. So he has to have the surgery, and there’s no point worrying about it because neither of us can do anything to change the outcome. Leo has made the only decision he can, and we’re just going to have to see what happens.

Leo has been totally cool about that. As for me, as I sit here waiting for the surgeon to finish his work and come out and tell me how it went, I’m wavering between somewhat cool and somewhat freaked out.

So, I’ve got my laptop plugged in, I’m on the hospital we-fi, and I’m waiting.

Update:

Surgery is over. Everything went well. He’s just been moved to the ICU. I’ll drop in on him there — because for some reason everyone expects me to want to see him unconscious and on a respirator — and then I’m outta here. There may be drinking in my future.

(I’ve changed names, places, and other details to protect my friends’ privacy.)

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