Lessons of the Heart, Part VIII: Ablation Surgery

 

On Wednesday, October 2, 2024 I underwent a two-and-a-half-hour heart procedure, and I believe that event may mark the end of a two year medical journey starting September 22, 2022 when I entered the hospital with a severe blood infection called sepsis.  Sepsis brought me close to death, and it also culminated in endocarditis (heart valve infection), severe atrial fibrillation (fast and irregular heartbeat), and led to eventual open-heart surgery to repair the valve, and two years of trying to bring the atrial fibrillation under control using medication (drugs).  It has been a long, challenging journey for me with many twists and turns to it.  I believe it is finally over, though I know other health issues will eventually present themselves as I advance in years.

I spent a total of six hours in the hospital on October 2: two hours surgical prep, two and a half hours in a surgery that was a spectacular success (see end Note appended below), and an hour and a half in recovery.  I want to share what I experienced, and what I felt, what I learned, and how I used Buddhist practices to engage the experience.

In entering the hospital, I consciously set my intention to connect on a personal level with the people who worked there.  I wanted to focus on “looking for the places we touch,” the places where we share a common interest, concern, fear, or happiness.  I wanted to be focused on recognizing that each person was much more than just their specific role in taking care of me that day.   This has been an important practice for me for several years now.

Buddhism teaches that we all want the same things (safety, freedom from pain and suffering, happiness, peace, connection with others) and that we all have something called  Buddha nature, which is the capacity or seed of kindness, wisdom, compassion, love, generosity, forgiveness, gratitude within us.   

My interactions began with Laura, the nurse who was assigned to prep me for surgery, and then to tend to me in the recovery room afterward.  I discovered that we live within a few miles of each other and we talked about what it’s like to live in a small rural town.  I ask if she worked a 12-hour shift and if she was tired, and we talked about how she felt about her job.  We agreed my surgeon is a wonderful doctor and overloaded, and I told her that an assistant to the surgeon had recently  told me that the hospital was hiring a second specialist in Eric’s specialization, who would start in January and help reduce his work load. We were both pleased about this.

I had two interactions with my surgeon, first before and then after surgery. I’ve known him for four years and we have an easy rapport.   He feels like an old and trusted friend.  We chatted easily about what to expect from the surgery and also the recovery afterward.   

Next was Michael, the anesthesiologist, who came to the prep room before my procedure to introduce himself.  He listened while I shared my personal concerns and anxiety about being awake for the whole two-hour-plus procedure.  I felt relieved by his assurance that I would not have to be awake or semiconscious during any part of the procedure. I could tell he was shy and nervous and tried to draw him out and make him comfortable by asking how he liked his job—something that was both interesting to me  and that would be easy for him to talk about. 

After I got home, I realized that I had missed a wonderful opportunity to connect with Michael in an area where we touched.  I had noticed that Michael had very muscular arms and shoulders that could only have been produced by intense weight training.  I’ve trained with weights for decades and it was a wonderful opportunity to compliment him on his hard work and success, and also tell him how he’s a better doctor for knowing about exercise first hand.  Most doctors have heard of exercise and know it’s good for you but have no actual personal experience with it. 

At the end of my prep time I met a nurse named Jake. We talked only a few minutes while he was wheeling me to the operating room.  He asked my profession, and I told him I had been a college philosophy teacher for 40 years.  Jake recognized an area where we touched!   He said I must have loved what I was doing to do it that long, and we talked about loving what you do in life and finding a calling, and he shared that his philosophy class was the best class he had in college.

My attempts to connect with the people around me really added a sense of ease and trust to our shared day together in the hospital.

A second intention for the hospital day was to remember to practice surrender to the prep procedure, the surgery, and recovery afterward.  

Surrender does not mean that I can’t set some boundaries for myself or ask for what I want, and it doesn’t mean giving up.  Surrender means dropping the mental resistance to what is real in each moment.  If my attitude is “I shouldn’t have to stay in the recovery room this long; I hate this,” that’s mental resistance.  Or if I say to myself “Why is all this happening to me; this is just so unfair,” that too, is resistance, and it causes unnecessary suffering.   Instead I practiced saying to myself “I don’t control everything that happens here, and what is happening here is the truth of this moment.  I say “Yes” to it. I say “Yes” to having tubes in my arm and a dozen electrodes on my chest.  This is the price of getting my heart fixed.  

I can also practice watching out for mental stories such as “I’m so hungry; if I don’t get some food right away, I’m going to pass out” (I had not eaten in 24 hours).  I practiced seeing these stories for what they are—pieces of fiction about the future—and then dropping them.  Complaining or saying I shouldn’t have to do this or the hospital shouldn’t be run this way does not change the truth that the hospital IS run this way, and it simply adds to my suffering   So I focused on surrendering to the truth of each moment—this is the way things are right now—as each moment unfolded. 

I found that a good surrender practice was to silently open myself to fully experiencing the physical sensations of resistance in the body, and then to meditatively acknowledging their presence by silently saying to myself “Hello resistance [on each in-breath]… I know that you are there [on each out-breath].”  Alternatively, I sometimes used the phrases “Resistance is here [on in-breath]… I smile to resistance [out-breath].”  

There certainly was no shortage of times when I could practice dropping resistance.   It began with having an IV drip installed in a vein in my harm (I don’t like needles, and a lengthy first try at it did not work), then having my groin and stomach shaved by a nurse and jabbed with the electric clippers, then some apprehension about the anesthesia, dealing with loud beeping coming from my monitor in the recovery room, drug after-effects and then boredom/antsy feelings in recovery, followed by extreme hunger. 

There was a time, after being in the recovery room about an hour, when most of the anesthesia had worn off, I was extremely hungry. It was 4:30, and I had been told I could go home at 5:00.  I noticed I was getting impatient and bored and longing for five o’clock.  Realizing my mind was in the future, I did a simple breathing meditation to bring it back to the present. During this time a beeping alarm on my vital signs monitor started sounding and then going off and then sounding again and I focused on opening to the sound and allowing it to just be there.

At some point, I got curious about the alarm and noticed that when I relaxed in meditation, the alarm would go off.  I started experimenting with my breathing and found that I could turn the alarm on and off by regulating my breathing.  If my respirations fell below ten per minute (according to the bedside monitor), the alarm would go off.  When my respiration rose to ten or higher, the alarm shut off.  At that point I realized that my mind was still feeling a bit restless and was sneakily casting about for some form of action or entertainment.  I said “Yes” to the presence of busy-mind and refocused of just being present. When it was 5:03 and no one appeared to begin discharge work, I pushed the call button to summon Laura so we could begin the discharge process.  Surrender to the present moment does not mean you cannot ask for what you want!   

The following part of my experience I call “Riding the wave.”  The most surprising and remarkable thing happened later that night when I went to bed at home.   I went to bed early feeling exhausted, when the truth was that the anesthesia had not completely worn off.  I was unable to go to sleep for two hours (until 11 pm), but it was a wonderful kind of sleeplessness—I felt totally energized and alert and full of numerous wonderful ideas for new blog posts, solutions to construction problems and working with interns and more.  I was concerned I wouldn’t be able to remember all this in the morning, so I got up and spent more than an hour writing it all down. It was exhilarating! 

This continued off and on (lying down to try to sleep and getting up and doing things) until 3:30 when I got out of bed for good.  The truth is that early on in the night I realized I was not the least bit tired, my mind was awhirl with good ideas, and I just decided to ride the energy wave and enjoy it.  And I did!

I had a lot of fun all night!  Part of what was in play here the realization that of course I was not tired—I spent 45 minutes sitting in a car getting to the hospital and sitting in the waiting room, laid on my back for two hours being prepped  for the surgery, then slept (was unconscious) lying on my back during surgery for two and half hours, and then spent another hour and half in bed recovering and waking up from surgery, rode in car again to get home.  I rested and slept all day!  I ended up totally accepting that I was going to stay up all night and I felt absolutely wonderful.  Will I feel tired later?  Maybe.  Will I suffer over it?  Only if don’t accept the truth of that moment, that “tired is here now.” 

As it turned out, I was awake for 38 consecutive hours and never felt tired until about the 39^th hour I was awake, and then went to bed at my usual time and slept wonderfully.  Had I fought—resisted—what was going on I would have had a miserable night.  What a wonderful lesson for me in acceptance.  As I found out later, my energy surge (which turned out to be permanent) was the result of having been taken off of a heart drug the day before surgery that I had been taking for two years.  When I researched it, the most common side effect was tiredness!  And this is especially true for people who have had prior heart surgery like me. 

 

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Note.  For those who are interested/curious, the procedure I had is called a catheter ablation.  Two tiny plastic tubes (called catheters) were inserted into my body through incisions in the two large femoral veins in my groin (one large vein for each leg).  These tubes were then threaded upward until they were actually inside my heart.  Tiny electrical wires are then threaded up through the tubes and inside my heart.  The doctor can “see” the catheters and internal parts of my body from an electronic scan that is displayed on a large computer monitor.

Once inside my heart the doctor, called an electrophysiologist (staff call him “the electrician”), can search for locations inside the heart that are emitting unnecessary and disruptive electrical impulses that cause the heart to beat much too rapidly and not in a proper rhythm.  Once these trouble-making locations are found, the heart tissue that is the source of signals is ablated (destroyed using either high intensity radio waves or freezing).  This corrects the underlying cause of the problem.

Here's the really good news!  My doctor looked in the most typical location where bogus signals arise for my type of heart problem and found nothing.  He continued to look and found a spot in my heart emitting unnecessary and disruptive electrical signals.  When he found that spot, he ablated it, and my heart instantly dropped out of atrial fibrillation and beat normally, almost as though someone had pulled the plug on the bad behavior.  Even better, when he tried to electrically jar the heart back into atrial fibrillation so he could look for other trouble spots, he was totally unable to do it.  My heart absolutely refused to misbehave!!!  Woo hoo!  This was absolutely the best possible outcome and looks like we may have an actual cure. 

 

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