Month: March 2013

It was now Saturday morning January 12, 2013, and I was expecting visitors today. I ate a good breakfast and decided, since I was no longer tethered to an I-V or the stationary heart monitor – thank God for portable technology, to move to the chair in my room. I had my new Kindle Fire (a Christmas present from my family) with its bright yellow case and a black Moleskine reporter style journal pad on which to write. Reading, reflecting, praying, listening and writing are sacred times for me. And those moments of solitude with God were helping me to ground my soul in a familiar relationship with him after a few days of unfamiliar experiences. I was feeling alive and connected.

The medical staff was very pleased to see me sitting in a chair. They took it as a very positive sign that I was beginning to recover. Also, while I was sitting, I received my second visit from Chaplain Josef who worked at the hospital and had found out about me from the Jesuit Brothers at Villa Saint-Martin where I had stayed earlier in the week. He asked how I was doing and we talked about Henri Nouwen, Jean Vanier who he had met and the blessing of God. His English was not so good, but we made a spiritual connection through the language of faith that was warm and encouraging. I was very thankful for his visit.

Curt arrived before lunch, as did my friends Gustavo and Paola. Gus had bought and brought me three newspapers as I had requested. I had arrived in Montreal the Saturday before and had spent the evening meeting Gus for the first time and reconnecting with Paola. She had gone to college at Oglethorpe University in Atlanta and attended the same church my family was in and had actually babysat our boys once or twice with her friend Katie. Gustavo and Paola are natives of Venezuela who had immigrated to Canada a year ago.

On the previous Sunday, I had gone to a church meeting in a downtown Montreal cinema hall, had an amazing brunch, visited an informative and educational archaeological and historical museum and eaten frozen maple syrup with snow, all with Paola and Gus. They had been amazing hosts and tour guides. We had experienced most of the day walking in a beautiful snowfall. And, actually, on that Sunday evening we had spoken our farewells and didn’t expect to see each other again for months. Of course, we would continue to connect via Facebook. And Facebook is how they found out about my heart attack. On Thursday night, Jenny used my account to send a message to Paola to tell her what had happened and to get them in the loop. Being a social media activist has its rewards!

So, a few days later, here we are in CCU Room 9 and they are watching me eat lunch and we’re talking about the events of the last few days. They were so caring and loving and offered to help in any way. And we would definitely avail ourselves of their hospitality in the next two days.

Dr. Lalonde was off for the weekend and another cardiologist was leading the care team. By the afternoon, Curt’s anxiety regarding my being able to travel on Tuesday and his being able to travel today or tomorrow was quite strong. He even tried to get a commitment from the chief cardiologist that I would definitely be discharged on Monday and be cleared to fly home on Tuesday. This guarantee would allow us to purchase a plane ticket for me, and my wife Jenny and son Jameson, to travel home to Atlanta. Dr. Lalonde had told me on Friday that he thought it would be very probable for me to be discharged on Monday and likely that I could travel via airplane on Tuesday. But, I don’t know if I would make that bet. I was feeling good, but wasn’t sure what to expect over the next few days and weeks. At some point, we came to a decision to buy the tickets. So, that was done.

I talked to Jenny a couple of times and exchanged text messages with her on Friday and Saturday. She and Jameson would be flying to Montreal on Sunday and arrive around lunchtime. And I think I talked to Justin and Jed sometime on Friday evening. It was a challenge to remember what day it was as time moved on in my hospital stay.

Since I was 1,206 miles from home, I didn’t expect to have many visitors during my hospital stay. So, it was a great surprise when someone would stop by to say, “Hello.” So far, only Curt and one of the hospital chaplains had visited me. No doubt I had experienced lots of comings and goings by medical personnel; it seemed like no one in a uniform could pass my room without coming in to take my blood, give me a pill or a meal, connect some wires and read some numbers or look at some lines.

Sacred Heart (HSCM) is a huge hospital founded in 1898. HSCM, with its 400 doctors and 3,800 employees, is a recognized leader in traumatology, orthopedics, cardiology, emergency, pharmacy, and other services. The hospital cares for more than 20,000 inpatients and 200,000 outpatients annually. And, on Thursday the Emergency Department was operating at 250% capacity due to a huge influx of patients with flu-like symptoms. I was thankful that I had received a flu shot a couple of months earlier. I would experience some of the impact of the crowded facility in the next couple of days.

Thankfully, at 10:00 PM on Friday evening [Since the angioplasty had ended around 4:45 PM, I had to lay flat for five hours to let my femoral artery rest. And the rest of my body needed a break, too.] I received a hot meal of meatloaf, carrots and peas, and tea and fruit. I hadn’t eaten since breakfast due to my angioplasty that afternoon. The meal was delightful. The new orderly for the night had just come on for the weekend shift and his name was “Jack”. I’m not sure of his country of origin, but was guessing he was Eastern European or the Middle Eastern. Jack spoke American-style English and seemed to have many friends around the hospital. He was a master at “transforming” my bed into a huge chair making it so much easier to eat.

Given the fluid in my lungs and taking the diuretic Lasix water pill, my urine was being measured and I was not yet able to go to the WC. So, I was successfully using a container while in bed. After 48-hours of successful use, I missed the container and wet the bed. Upon seeing Jack, I motioned for some help. Did I mention that Jack had a loud voice? Well, soon there was a couple more staff in my room to help remove the sheets and remake my bed with me in it. Fun times.

As Jack was finishing making my bed, the other staff had left, a couple of his friends passed by my door and caught his eye. I was rolled over on my left side and he’s now in the hall having a good ole reunion and my gown is not fully covering me. “Hello!” I’m thinking. Jack came back shortly as if nothing had happened and I was lying on my back again on clean crisp sheets. It’s all a part of life in the hospital.

Later, I apologized to my weekend night nurse, Martine, for being rude when they were transferring me from the post-op hall to my room. I had felt that I was not the most respectful. I felt I had been demanding and complaining. She said, “You? You were not rude. I began my career in nursing in the Emergency Room. I know what rude is and you were not rude. Nothing to worry about.”

Martine had dark red hair and 7 pierced earrings on her left ear. Her English was not bad and I felt she cared for her patients and was pretty quick to listen or observe and size up a situation and decide on the best course of action. It was probably her ER experiences that increased her response time to the needs of others.

On Thursday, Lind had secured a large radio for my room and set it to an English language pop station for me to enjoy. I had shut it off at night, but it was good to have some music in the background. There was no TV in the room and just one comfortable chair.

My CCU room was modern and large. It also had individual HVAC temperature controls. I asked Martine to lower the temperature a few degrees so that I could sleep. I slept extremely well. Someone added a light blanket during the night to cover me and I had what would be my last good night of sleep for a couple of weeks.

We pick up the story in the late afternoon around 3:40 on Friday January 11th. Pretty soon, Dr. Charron came by again. He wanted to give me an invoice (I had no place to put it!) and talk about today’s procedure. We were all more relaxed. There were smiling faces and calm voices. This was quite a contrast from Wednesday. Dr. Charron said that everything should go very well, but that some folks have another heart attack during an angioplasty procedure: “About 5%,” he said. I already knew I was in a special minority. I didn’t need to be in that 5%.

As the nurses rolled me into the O.R., there was cold air and two people lifted me on to the table. One nurse taped the oxygen monitor to my left index finger, then flipped up the arm holders on each side of the table. I had hoped that they could use my right arm again as the entry point for the tube and stent, but it was not to be.

Dr. Charron said that he was going to go through my groin and femoral artery for the heart catheterization and angioplasty and placement of the stent. A nurse asked me for the English word for “groin.” The doctor said that the blood pressure in my right arm was not strong enough to go through my radial artery again.

So, this time when the nurse said that the application of the iodine paste was going to be cold, I knew what to expect. She was more comprehensive than before and covered me from my waist down to my thighs with an iodine bath of the slush-like liquid. This was followed by fabric and then paper covering me from neck to feet. Next, one of the doctors injected the lateral groin area with local anesthesia. He injected a couple of times in the area where the slit and insertion point would be. While a high pain threshold can be a problem, it is a blessing for situations like this when I’m receiving multiple sticks and pricks.

In short order Dr. Charron made a small incision and then was inserting the Seldinger needle at a 30-45° angle into the femoral artery. A guide wire is then inserted through the needle into the artery and the preparation for the journey to the heart begins. The needle is removed and the catheter sheath and dilator are pushed over the guide wire. Then the dilator is removed and the sheath is ready to receive the catheter. I could feel the process begin as Dr. Charron pushed a tube through my lower abdomen in search of the right coronary artery that was 70% blocked. The plan was to open up the artery with a balloon and then place a 4 x 16 mm stainless steel or cobalt-chromium alloy mesh stent to keep it open with 0% blockage.

After some time of injected dye and moving the x-ray machine around so that the doctors could see where everything needed to come together, I began to feel the pressure and burning that had been my dreaded companion on Wednesday. “Surely not,” I thought. “Am I going to be one of the 5%?”

I said that I was feeling pressure like I had on Wednesday. Dr. Charron broke from a steady banter in French and spoke to me in English, “It’s perfectly normal. We’re close to being finished.”

My anxiety decreased, but my pain stayed steady. What an awful feeling. Soon the pain began to quiet. The tube was being removed and a huge rolled up fabric bandage, like a towel was pressed tight across the right side of my groin area from my waist to between my legs. It was secured with tape. Then another doctor came over to massage the area of my femoral artery. A vascular closure seal had been positioned on the outer surface of the artery and would be resorbed within 60-90 days. The massaging helped the artery settle back into it’s naturally protected position. I was not allowed to sit up for several hours because of the fragility and danger of leakage with this artery.

Dr. Charron drew my attention to the large video screens to my left and showed me before and after pictures of my artery. His work was called percutaneous coronary intervention [PCI]. What I saw was a picture of brokenness being restored to shalom – all was as it should be now. No doubt it is similar work that the Holy Spirit performs in opening the hardened places in our spiritual hearts so that life-giving blood can flow.

I had no oxygen mask this time. I was transferred to a rolling bed and moved back to the “on deck” room – pre-op was now post-op as patients were intermingled in this large banquet hall. My whole time in the Operating Room equaled 60 minutes. Wow. A life-saving deed was done to/for me in only an hour. Years of training, discipline and experience allowed these medical people to efficiently and effectively “fix me” in the time many of us spend watching an episode of our favorite TV program.

I was feeling better, but was tired and hungry. When I returned to my room in CCU, I was told I might could eat dinner at 10:00 or 10:30 PM. It was 5:00 and most of the other patients were receiving dinner right then. I needed to rest, take a couple of pills and empty my bladder.

Curt had returned and was in the room shortly after I had gotten settled. I had to lay relatively flat due to the femoral artery, but I wanted to sit up and talk. Curt was getting a bit hyper about next steps and when he should make plans to return to Atlanta and when Jenny could fly to Montreal and then return home with me. We had more questions than answers. It was frustrating, but we learned that we approach situations differently and thus should not project our expectations on to others.

I was beginning to fall asleep, so, Curt headed back to the villa. And I rested.

Early on Friday, one of the nurses, Lind, said that I was on the list today to have another angioplasty procedure to address the right-side artery that was 70% blocked. Dr. Lalonde had been successful in having a conversation with someone with my insurance company, and even “assigned a case number,” but there was no decision making authority given to the customer service rep. Dr. Lalonde had laid out the option of transferring me to a hospital in Atlanta if my insurance company had wanted that. Neither of us was aware that south of the border, Jenny had also spoken with the insurer and found out that they would cover my care just as if I was in the US. Sacré-Coeur Hospital was, of course, “out-of-network” but the cost of medical care was so much lower in Canada that it would prove to be a windfall for us and our insurance company.

Eventually, I decided to follow the direction and protocol of the cardiology professionals at Sacré-Coeur and do the second stent. It was like I had dropped the puck for a hockey game. Very quickly, my lunch was cancelled and preparation began for me to be taken into the pre-op area. Curt left for lunch and at 1:30 pm I was carted to what some hospital’s call the cath lab patient lounge. This is where patients who have scheduled angioplasties wait for the next available doctor to work his/her magic.

Today, I was told, there were two cardiologists doing a tag-team rotation in placing stents in overcrowded arteries and likely preventing future heart attacks. My new BFF Dr. Charron was one of the doctors in the rotation. I indicated to Lind that, everything else being equal (meaning I had no emergency), I’d prefer him since he had already seem my arteries and heart up close and personal. She said that she’d pass the word.

As I lay on the gurney, small preparations were being in a casual and unhurried fashion. Quite different from Wednesday evening. A new I-V was attached and I signed a form permitting the procedure. I had also talked with Dr. Charron and agreed to pay him with cash for his work in ostensibly saving my life and now preparing me for clear arteries for the future. Since he was an independent contractor to the hospital, and would bill me separately, the potential for him not getting paid was his concern. He had sent bills to US patients in the past and not gotten reimbursed for his time and talent. That seemed hardly fair to me and I gave him my word that I would pay him before being discharged.  I figured that was a pretty good incentive for him to do another good job. He had already explained the risk of the procedure and my only interest was in the percentage of patients who have a heart attack. He said that it was 5%. Again, if he wanted to get paid, then he better not let me be in that statistic! His professional services in doing my angiogram and angioplasty in the emergency mode was $1,800 and the planned one he was about to do was $800. Experts have told me that his $2,600 bill could’ve been $15,000 in the US.

As I laid on the bed in pre-op, I was still trying to take it all in. I was wondering when Jenny should fly to Montreal. It just seemed odd that on my, and soon Jenny’s, only visit to Montreal that I would develop chest pains and then a heart attack. Perhaps it was the connections I would make with Nathan, Paola, Gus, and Curt that were important. “That important?” I asked. Given that I was apparently going to have a heart attack at some point, was there a way to use the location of Montreal as a rallying point for others?

What is the providence of God that orchestrates details like this?

This is probably a good place to mention an example of providencial details that I’d experienced in the midst of this life event. Over the past few months, I had been reading Sabbatical Journey by Henri Nouwen. This ended up being Henri’s journal of the last year of his life on earth. About a month after he had completed his sabbatical and returned to L’Arche Daybreak near Toronto, he made a quick trip to his Dutch homeland to meet a film crew with whom he was producing a documentary. The subject of the film was the Rembrandt painting Return of the Prodigal Son that was hanging in The Hermitage in St. Petersburg, Russia and had been such a powerful image in Henri’s life. While still in Holland, Henri had a heart attack. Within a few hours, my friend Nathan Ball, who had been one of Henri’s closest and best friends for the previous 12 years and was community director of L’Arche Daybreak , was on a flight to visit Henri in the hospital. After a few difficult days, Henri’s health improved and it looked as though he was going to make a good recovery. Sadly, after a couple of good days he suffered a second heart attack and died at 64-years-old.

In the past five years, I’ve read over 30 of Henri Nouwen’s books and feel like he has been a major influence in my walk with God, family, acquaintances and friends. Nathan has been instrumental in guiding the Henri Nouwen Society and Henri’s Legacy. Nathan wrote the Afterword to Sabbatical Journey. The night before my heart attack, I shared some of my connections with Henri and the impact of his writings on my life with Nathan. I asked Nathan about that last week of Henri’s life and if Henri knew he had heart problems. Henri had not been aware of any heart problems. He talked about the ways that Henri had made commitments to slow down his activity and change his work patterns. Nathan told me about the recent radio documentary and biography that had been released in Canada. He also said that he would send me some copies of books that I might not have seen. It was a special conversation for me and one that I will cherish for a long time.

Needless to say, we had no idea what would happen the next day and that Nathan would be holding my arm as I entered the hospital. As I reflect on that 24-hour period, I’m amazed at the mercy and charity of God that gave me a gift in the midst of my loss. I will always appreciate the presence of Curt and Nathan in my very difficult situation. It was a gift from God and a picture of true community.