My Tryst With Destiny

MY TRYST WITH DESTINY

At about 5am on Wednesday the 25^th June (it was a muhurtham day as later in the day I should have gone to attend wedding of daughter of  a colleague) Jaya woke me up saying that her stoma bag possibly needs attention. I examined. She was right. This is “mucus fistula” left behind after the transverse colostomy was carried out 2 ½ yrs ago because sigmoid was adherent to urinary bladder consequent to radiation given in 1994. (GI Surgeon and urologist were not confident of repairing this without causing greater harm. My problem was that the ‘bag’ was on a skin fold and bag needed change every other day. I was very uncomfortable with this.)  A temporary patch work was done and I prepared a new bag by enlarging the aperture. Meanwhile milk had arrived and Jaya suggested that I attend to the bag after coffee. I gave her and returned to my Ikea reclining chair for sipping mine. Noticed retrosternal ‘discomfort’. I had taken only a couple of sips of coffee. No alcohol the previous night. The ‘discomfort’ soon became ‘pain’ confined strictly in the “retrosternal” region. No radiation. No vomiting. Like my friend Jagan (neurologist) in exactly similar situation did, I also gulped down an ounce or more Gelusil. No relief. Urgent desire to defecate and passed brisk stools & could wash without difficulty BUT the pain did NOT abate a wee bit. On the contrary severity was increasing rapidly & I then had no doubt that I am ‘cooking my coronaries’. I went to Jaya in bedroom saying the same thing “Jaya, I am cooking my coronaries”. Poor thing, she did not understand what I was saying! I located the list of numbers I had left with her to call in any emergency and asked to tell whoever comes on line to come over quickly because “Kannan has pain in the chest”. That unnerved her and in her panic could not hold the phone to dial. I returned to my chair in drawing hall & started dialing. 4th person who answered was Dr.Palanisamy. “Jump into your car & come & take to hospital. I have developed ‘typical cardiac pain’” I ordered. While waiting for him I called up Dr.Satyamurthy, cardiologist. He was in the toilet (where else at 6.15 am!) .I requested his wfe to ask him to reach Apollo immediately FOR ME. Now the wait for Palanisamy to arrive. Most harrowing time. Pain was constant now but severe still without any waxing& waning. Suddenly I remembered description of ‘cardiac pain’—“a premonition of impending dissolution”. Believe me ,that was what I felt reclining in the chair. I let out a scream “ will someone please give me Morphine?” Jaya was blabbering something and pacing up & down. Hearing my scream she came up inquiring what was it I wanted.  Palanisamy had not yet come. I looked out of the window to see if Venkat’s car (s/o Thyagu E!,downstair neighbor) was parked. He sleeps the night in E1 to take care of his ailing mother. No it was not there that day. I slipped into a pant & WAITED! Palanisamy arrived ( He told me later that he took only 12 minutes reaching Snehasadan. (No it was eternity!). He examined me quickly.Pulse was steady, Heart sounds normal.(I asked him for S3!—he ignored me) Lung bases were clear. JVP was normal. (how I love clinicians who still examine the patient first) With him I climbed down the steps ,at the same time asking Jaya to call & ask some one to come over & stay with her. Let myself into the car Santro AT. He reassured me as he was driving out of Snehasadan that “you are alright Sir. “ “ No sweating.Good” . I realized that a well known accompaniment of cardiac pain was missing in me. (Recalled what I used to teach –sweating is an epiphenomenon resulting from fright and adrenalin overdrive! (Brisk bowel movement instead of sweating!) Wont you sweat if you step on a snake?—Another 12 odd minutes we reached the doors of Emergency in Apollo. It was indeed providential design that Palanisamy was contacted by me (instead of Suppamani, Nirmala, Sankar) because efficient administrator that he is he had warned the emergency, asked couple of PGs to be present there, alerted the cardiologist on duty as well as the cardiac cath lab .7.30 am: Apollo emergency--Well wheel chair was not there!! Ankit (PG in GE) Shanti with her husband Babu, Sarojini were all there, requested me to wait for one but I walked the few yards to the couch and the “works” were set in motion. I was stripped, ECG connections were attached, shaving of both groins and both cubital fossa done almost simultaneously! , IV line set up. IALL in a jiffy. I gave my mobile to Ankit & asked him to call my daughter Suba, No response as he showed the phone I saw he had dialed my niece Shuba .Showed  Suba’s number on favorites. As soon as I heard Suba’s voice I choked and could not say a word and even cried a bit ,all for the first time that morning. I missed her badly at this juncture. Gave the phone back to Ankit. ECG had been taken by then & he briefly informed her about acute coronary episode. I had recouped by then & spoke to Suba. Admired how mature my daughter is. She calmed me ,assured that now that I had reached in time all WILL be well. Spoke to Jaya informing her of coronary angiogram .Somewhat relieved that Sankar had reached E3 to be with Jaya.

I said aloud why morphine was not yet given.Pramod replied that 3mg morphine was being given IV. I could peep into the ECG. Noted elevted ST in some leads & knew that it was an acute myocardial injury. Pramod (about Sarojini’s seniority) cardiologist on duty chided me for trying to read the ECG! “Informed consent(!) “ was signed by me and I was wheeled into cath lab. Saw Nirmal, Sarojini ,Shanti there wishing me all the best.Transferred to the table, Satyamurthy patted to say he had reached. My pain reduced 50% !( I recalled seeing the relief on my patients when they know I was in the procedure room!I am sure if Satyamurthy had not reached in time Pramod would have attended with equal expertise and success. But still---) Angio, Ballon dilatation and stenting done,back in cardiac ICU , ALL done within the next 50 minutes. As I was wheeled out to cardiac ICU I noticed Sailam & a few more had landed. Such news spreads fast! On the way to ICU I spoke to Suba this time smiling because the pai had just vanished. “So quickly appa” was her reaction. (I was to know later that entire procedure took all of 45 MINUTES!)Rest relax & sleep ordered my loving daughter. Informed Jaya that needful had been done and I feel fine. Was glad to know that Revathi was comjng in a taxi from Bangalore.

Cardiac ICU was under renovation .Therefore I was admitted to a make shift arrangemen of a veranda converted to a ward. It didn’t make any difference because there were curtains all around . As soon as balloon dilatation was done pain had VANISHED TOTALLY.  I felt exhausted and sleepy. But I was to realize soon that one place where even Kumbakarnan cannot sleep was ICU. Two companions were on ventilators & every now & then NOK entered and let out a loud wail .Ward staff ordered them to be quiet or simply (said in mallu accent) escorted them out of the ward. But damage had been done, My sleep disturbed. My neighbor was in extremis with COPD receiving O2 thru tight fitting pressurized mask. Moment his cerebral anoxia improved or hypercapnia decreased he started pulling off the mask loudly cursing everyone around .I asked Anita (doctor i/c of ICU---she was a resident under me two decades ago!) why tracheostomy was not done. NOK refused permission. She managed to somehow restore some peace & quiet .i could sleep. Not too long! Pulse/ Bp/ Temp had to be recorded .I was hooked on to a gadget which was monitoring all these parameters but ISM (Dr.Satyamurthy) would trust only the good old sphygmomanometer. Anita ensured that I should not be woken up unless the monitor showed changes that needed confirmation. Heavily bandaged right groin weighed a ton and I was warned (!) that I can move all parts of the body but not the right lower limb.  Try & do that! After a few hours legs did not pain but the back started hurting thanks to lying flat all the time. “Just one day, Sir” nurses said one after another. On the left cubital fossa was an IV line. (I was amused to learn later that the only IV medication I received was Pantocid,.I informed the cardiac registrar that peak blood  levels when pantocid is given IV is only 3 hrs while by oral route it is 10 to 12 hrs. ) Of course How can a patient be kept in ICU without a IV line?! Night was relatively peaceful—one of two on ventilator was “declared” - --(meaning dead in Apollo parlance). COPD was moved to far end of the ward, I was helped to turn on my left. What a relief! Could sleep.

Next morning ISM walked in with his retinue of assistants & PGs. After quick assessment ordered transfer to ward. Shanti had already identified and blocked a room. Biggest relief was to see sunlight & outside world. Why should ICUs be shut out from day light and view of outside world? Could use the toilet for voiding urine! And I slept soundly practically the whole day. They had even detailed a special nurse whose main  task was to fend off visitors. Permitted ‘cardiac diet’ (no dessert!). ISM decided that I can be discharged on Monday (admitted on Wednesday). In the evening cardiac PG dropped in to do routine check. I asked him how many coronary stenting he had assisted. Quite a few Sir.”well, tell me about drug eluting stent. What is the drug that elutes & so on” I was not testing him but genuinely desired to know. Poor fellow turned pale. He mumbled some words but just then visitors came in. He was saved by the bell! If he was my PG he would have received a mouthful.

Suppamani escorted me home.Nisha had brought the ‘stair chair’ down. I was back home.

Reflections: 

When on that morning retrosternal pain was severe and Palani had not yet arrived ,I did not pray. Why? I don’t know why it did not occur to me .

Why did I not ask for ambulance from the hospital. Apollo ambulances are fitted with all equipment including defibrillators and technical assistants trained to use them. 

Did I miss warning symptoms? I cannot recall any for a week prior to the day of pain.

Thanks:

 Dr.Palanisamy,  Dr.Pramod ,   Dr.Satyamurthy , Dr.Anita.

Feels nice to be alive!