A Procedure From Hell

 

The cardiac catherization was scheduled for 12:00 noon, I got there at 11:00 a.m. and the preparations began with shaving of my chest, my wrists and my groin area.  I asked why the groin area since all indications were that the doctors were going to access the arteries through the wrist.  She indicated that she had to prepare both areas in “case.”  I did not bother to ask what “in case” meant.  The first thing I noticed was the reduction of staff since last time I was there.  There seemed to be less nurses and no orderlies.  I waited for an hour and finally an operating room (OR) nurse came for me (not an orderly) that normally take patients from the prep/recovery room to the surgical area.  Moreover, the OR nurse was upset that the attending nurse had not placed the IV and had not given me the proper releases to sign.  She had me sign the release forms and decided that the surgical team would insert the IV necessary for the procedure.

 

Four attending nurses proceeded to find my vein to insert the IV.  One female and two male nurses.  They could not find the vein in my arm and proceeded to search for the vein in the back of my hand.  They thought they found the vein and proceeded to “poke” me four times looking for the vein but could not find it.  They then decided to use an ultrasound machine to look for the vein.  It was like a comedy skit each trying to identify where the vein was and how deep it was using the ultrasound machine.  They finally called and “expert” phlebotomist who joined in the exploration for the vein in my arm.  He inserted what felt like a large animal syringe that hurt like hell a couple of times moving it up and down and back and forth trying to find the vein.  Finally, after seven pokes, they managed to insert the IV and began to strap me down on the operating table.  They placed two large patches, about the size of my extended hand, which seemed to be taken out of the freezer, and put one on my back and one on my chest. 

 

By this time, I was shivering from the cold, and they placed a blanket on my lower legs.  They informed me that the procedure was going to be performed from the groin.  I was not happy about that since I was prepared for them to access the artery from my wrist.  The doctors came in, some pleasantries were exchanged, and they informed me that I would be feeling the medicine being introduced into the blood stream and to inform them of what I felt at the time.  They gave me some medication in my IV to relax me, which did not seem to help, but the local anesthesia around my groin area did help since I felt very little pain.  I did sense the cables being inserted and could see the large monitor they were using to guide the probe to the proper artery in the heart.  It was difficult for me to see the monitor since the large sensor over my chest blocked most of the view.

 

There was a lot of discussion between the team of five people and between the doctor and me.  He asked me if I felt the dye being inserted and I indicated that I did, first in the left shoulder, then in my left wrist and then in my chest.  It felt like a very warm liquid was being injected.  I don’t know why I felt it in my left arm since all the activity was on my right arm.  At no time did I hear the word “stent” being uttered.  There was non-stop discussion about what seemed to be instruments and about forty minutes into the procedure I began to feel some pain in my upper chest and a sense of scrapping inside.  I told the doctor about this sensation, but he only indicated it was their doing. 

 

I then began to feel a sense of pressure, like the feeling I get when my blood pressure rises near or over 200/95.  This did not feel comfortable, and I informed the doctor of my apprehension.  He ordered that I be given some pain medication through the IV and a high dose of Plavix, I think the nurse mentioned she was giving me 150 mg in pill form.  She put the pills in my mouth and gave be some water in a small cup to help me swallow.  The pain medication had some effect, but I could still feel the cables that were inserted and being moved around, and I could sense the movement (scraping) of the instruments in my chest.  Although I did not feel the pain, it was not comfortable, and I was apprehensive.  After what seemed to be nonstop discussion and nonstop activity for about half an hour, the doctor gave the order to withdraw all the cables.

 

My cardiologist left the room and the other doctor, who was operating the cables, closed the opening in the artery in a very efficient way.  In fact, I felt very little pain during that procedure.  The main monitoring instruments were moved back and the team of three nurses (two men and one woman) began to untie the straps that held me to the operation table and remove the patches in my back and chest.  They half rolled me to one side, placed some sort of cardboard-like flat surface under me and slid me on the gurney they had put next to the operating table.  They took me back to the recovery room where I proceeded to be monitored for four hours and then the nurse released me.  They gave me lunch, roast, carrots, potatoes and a turkey sandwich.  I had not eaten since the night before.

 

The doctor never talked to me before or after the procedure.  But I later heard that he had performed Angioplasty.  Although no additional stents were used, this was performed up from the artery from where the stents were.   A balloon angioplasty is used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis.  A deflated balloon attached to a catheter (a balloon catheter) is passed over a guidewire into the narrowed vessel and then inflated to a fixed size.  The balloon forces expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow.  A new stent was not inserted so I suppose the doctor expects the artery to remain open.  The balloon is then deflated and withdrawn.  As I understand, one of the arteries was nearly 100% blocked and the other was 95% blocked.  Without a stent, I am not sure how long the arteries may stay open, but I may have to have the same procedure performed in the future.