Week 15, Day 6 & 7

Let's call it the Joseph A. Banks deal of heart procedures. Go in for three stents to open up obstructed arteries, come out with four -- two in each artery. The surgeon, Dr. William Morris, said he decided to use two smaller stents in place of a larger one.

This time there was hardly any wait in the cardiac staging area at Gates Vascular Institute. I rolled into the operating room a little after 11 a.m. Monday and out around 12:30 p.m. Dr. Morris said he was pleased with it. Great. If it's OK with him, it's fine by me.

He went in once again through an artery on my right wrist and I scarcely felt anything, aside from a little pressure in my upper chest, a pressure that reappeared briefly in the afternoon, but it's been gone ever since. I could see a few things -- the probe and a stent, which looked like a bullet on the video screen -- but not the doctor or the nurses, who were mostly behind big baffles. 

Health proxy Bill Finkelstein and I had checked in at 7 a.m. and were delighted to discover that we'd be back in Room 25, a suite with floor-to-ceiling windows looking north onto a rainy day. Finding a good vein for the IV again was a problem. The first nurse gave it two tries, then called in a colleague, who examined my left arm for a couple minutes, found a spot near Friday's IV mark, and nailed it. 

The rest was just waiting and welcoming a parade of nurses and aides collecting blood samples and vital signs, a procession that continued every couple hours all afternoon and night. "Nobody sleeps in the hospital," one of the nurses noted. Still, all my vital signs were in order. I felt good. Restless, even. 

Bill left mid-afternoon Monday and missed my only visitor, bridge player David Donaldson, who showed up around 5. Monica, who came at midday, stuck around until the dinner hour, working on her computer. While waiting until it was safe to eat, I reached a long-awaited reading milestone. For the first time in decades, I'm up to the current issue of the New Yorker. 

I broke my daylong fast with the fruit plate with cottage cheese. In the spectrum of hospital food, it's a hard one to screw up. Later on, I phoned in another request for mandarin oranges, a yogurt and a chocolate chip cookie. The tray appeared with oranges and two yogurts, no cookie. Cookies must not be heart-healthy. Same thing happened Tuesday morning. I ordered toast. It came with no butter.

Eating like that was one of the discharge instructions from Amey, Dr. Morris' assistant, along with advice to take it easy for a while and avoid anything strenuous, like yard work or weight lifting or running marathons. She said I'd probably feel tired. She was right. At the moment, even after a nap, I still feel drained. 

Week 15, Day 3

          “Didn’t feel a thing,” I announce triumphantly to health proxy Bill Finkelstein as a nurse named Trish wheels the gurney into the room/suite Friday afternoon at Gates Vascular Institute. And for good reason. Nothing happened.

          Dr. William Morris, ready to install three stents in my heart arteries, had an emergency case in the morning and then gets called back to do more work on the patient in the afternoon. I lie on that gurney in the staging area for 90 minutes, saline solution dripping into the IV in my arm, before Trish comes along to say Dr. Morris is going to be much later than expected.

          The doc himself comes down to the room/suite shortly after 3 p.m. to apologize and relate that he has two in-patients to work on before me. That would get me into the operating room really late, he says, and he would not be at his best. He’ll see me first thing Monday morning. Well, second thing, after his assistant, the animated Amey Dziulko, reminds him that he has a left-and-right that morning that needs to come first.

          So everything is on hold for the weekend. Dr. Morris assures me that I would live until Monday. And it gives the blood thinning meds three more days to kick in.

          This turn of events leaves much to unravel early next week. Appointment with my sleep doctor Monday morning? Canceled. Bridge partners Monday and Tuesday? Notified. Sunday night sick day at The Buffalo News? Reinstated as a working day, but now I’ll be off Monday and Tuesday.

          All this after a day that seemed to start off well enough at 9 a.m., after a couple adjustments. When they assigned me to a dismal windowless inner room, Bill Finkelstein finagled us into another one of those room/suites with a view, like we had Wednesday. And then there were my hard-to-find veins, which resisted volunteering for IV duty until a second nurse came in and shifted from the right arm to the left. Will things fall in line as smoothly on the return visit at 7 a.m. Monday? Here’s hoping.

Week 15, Day 1

         It turns out that I’ve been a heart attack waiting to happen. And indeed it did happen sometime earlier this year, probably in the middle of February, during that week when I was so wiped out that I spent almost all my time in bed. Not that I really noticed at the time.

          All this gets confirmed Wednesday with an angiogram at Gates Vascular Institute, successor to Millard Fillmore Hospital on Gates Circle and now a slick, modern appendage to Buffalo General Hospital in Buffalo’s ever-expanding Medical Campus.

          The personable angiogram doc, Dr. William Morris, no relation to the theatrical booking agency, delivers the verdict a couple hours after taking a look inside my heart via a catheter threaded up through an artery in my right arm.

          One of my heart arteries is completely blocked, he says. That was the heart attack. Two others have major obstructions – one is 70%, the other has three restricted areas, two 70s and a 90. There's a fourth one, too, and it's OK. So I’ll be back at Gates on Friday, when Dr. Morris will use the same arm artery to install heart stents. Following that, an overnight hospital stay and four weeks of generic Plavix, which will thin out my platelets.

          The upshot of all this – my bladder surgery is postponed until June, date to be determined. As Dr. Morris notes, the heart problems have to be taken care of first. Hopefully, the delay in the surgery won’t cause complications. I may be cancer-free for the moment, but the bladder won’t let me stay that way.

          So there are several blessings to count. First of all, thanks to that accidental second-time-around EKG two weeks ago, I’m not going to suddenly clutch my chest and drop dead. Second, I’m not going to expire unexpectedly when Dr. Guru and his robots are digging out my bladder. Third, now that I have the month of May for yard work, I’ll get to plant flowers. (Downside – I’ll be in recovery mode during the run-up to the Garden Walk at the end of July.) Fourth, I’ll get to play bridge in the Rochester Regional Tournament in mid-May, the first Rochester regional in many a moon, which I was very much looking forward to until surgery started looming.

          Minor blessings: They call the hospital rooms “suites” at Gates Vascular Institute and sweet they are, amenable as rooms in good hotels. Spending Friday night there will be a pleasure.

          Dr. Morris did the procedure through my arm instead the artery in my groin, which is more common and which would hurt more right now. “Dr. Morris doesn’t go through the groin,” his associate physician said.

          Time for the procedure was set back to mid-afternoon on Tuesday, then pushed ahead Wednesday when a big case suddenly came up. The nurses and aides had to rush to prep me. At one point, they felt like backstage assistants prepping the star between scenes – one was asking questions, another was inserting the IV, another was taking my blood pressure and still another was shaving my arm for the catheter.

          I wasn’t knocked out for the angiogram, just dosed with something to make me feel relaxed, which is what Tuesday bridge partner Florence Boyd said would happen, having had one at Gates a little while ago. She also said you could watch the procedure on the doc’s video monitor, which I did. Not very revelatory to my untrained eye, but I caught glimpses of the wire-like probe and some dark squirts of dye.

Week 14, Day 2

The cardiology department at Roswell Park Cancer Institute rings the phone about 10 minutes before the alarm is set to go off Thursday morning. The cardiologist wants me to come early for the afternoon appointment. He wants an echocardiogram.

An echocardiogram is probably the easiest procedure I’ve undergone at Roswell Park. They just put the gel on various parts of your chest and abdomen and roll the gizmo over you. My heart at work sounds like a washing machine. The technician says everything is fine.

The cardiologist, Dr. Edward Spangenthal, says everything is not necessarily fine. He brings out print-outs of my EKGs from December and last week, points to the differences and says there definitely was a heart attack, even though I was unaware of it (someone I talk with tonight experienced the same thing – he calls it a “walking heart attack”). Not a bump in the road that I want to hit. I signed up for bladder, not heart.

At any rate, Dr. S. wants to know if there are any blocked arteries. He wants more tests, the “gold standard” being an angiogram. For that, I get my first look inside Gates Vascular Institute, the new place next door to Buffalo General Hospital, on Wednesday. 

Week 13: Day 3

  I start my last pre-surgery visit to Roswell Park Cancer Institute on Friday by sticking my nose into the phlebotomy unit to say hi and offering to give a blood sample just for old times' sake. No blood test on the agenda this time, I explain. Then at check-in in the urology department, the aide says yes, there will be a blood test and I should get it done right now. Back across the hall to phlebotomy and I put Justine to work. She's good at drawing blood. Hits the vein on the first try and it hardly hurts.

  Then it's back over to urology to wait for the consultation with the surgeon, Dr. Guru. But first there's a session with a nurse's aide, answering questions about meds (no changes) and how I'm feeling (no pain). And then there's a session with an assistant to Dr. Guru, who explains a few things about the surgery. And finally, an hour after my appointed hour, there's Dr. Guru himself, who explains a few more things about the surgery.

  The whole robot-assisted procedure will take about six hours (no coffee breaks?, I ask). There will be one larger incision and several smaller ones. I'll probably need blood transfusions. The incisions won't hurt so much afterward, he explains, but because my lower body will be elevated during the surgery and blood will collect in my head and upper body, I'll feel like I've been beaten up everywhere else. There will be a day or two in intensive care and not-so-intensive care, then a regular room. The whole hospital stay will be eight to 10 days. 

  When I get home, I'll be able to go up and down stairs, but not too many times a day. In Dr. Guru's estimation, I could return to near-normal activities in another four to five weeks, which is less than the three months I've been told to expect. Health proxy Bill Finkelstein remarks that I shouldn't rush things while I'm recovering. 

  Dr. Guru also goes over the list of complications and the chances that any of them would occur. The biggest one is infection, which happens almost half the time. I'll need to be careful. As for surviving the surgery and its aftermath, the chances are very good, more than 95 percent. 

At any rate, he says I've come through chemo well. The CT scan shows there's no sign of cancer outside my bladder, although there's scarring on the inside. And for me to be completely cured, the bladder has to go, along with the prostate and a couple nearby lymph nodes. I shake hands with him as he leaves and tell him I have full confidence in him. Me and God, he says.

  Then, running an hour and a half late, it's over to the anesthesiologist. But first they give me a quick EKG to check my heart. When the doc, Dr. Sroka, comes in, he says an EKG shouldn't have been necessary because I had one in December. It was a mistake to do it, but it turns out to be a fortunate mistake. The new EKG does not look like the old one. Did you have a heart attack? Dr. Sroka asks. Not that I know of, I say. Could the chemo have caused one? Was that why I was so weak in February? 

  Dr. Sroka says I'll need to see the cardiologist, but by this point he's gone for the day. They'll need to do a CT scan and maybe an angiogram. And then there's a consultation with the stoma nurse, which was added at the last minute to my Friday appointment list, but she's gone too. So this isn't my last visit to Roswell Park before surgery after all. I'll be back next week. 

Week 13: Day 1

          How liberating it felt to go to Roswell Park Cancer Institute on a Wednesday and not report to the chemotherapy department. This time it was up to the second floor for a CT scan.

That involved fasting until I got there at 1:30 p.m., a drink of a cold berry-flavored prep solution, then waiting. Once I finally got called in to the radiologist, there was an infusion of dye into my veins, which produced a tingle from my head to my groin; and then a couple trips into the doughnut hole of the CT machine.

Mine was the last CT scan of the day and, subsequently, I was the last patient of the day for the urologist, the dapper Dr. Saby George, who said this would probably be the last time we see each other. He said he looked at the CT scans and saw no cancer. For the moment, I am cancer-free. Only about 33 percent of his patients reach this, he added.

Nevertheless, the bladder will have to go. The cancer had invaded the muscle wall and it has a high chance of recurring. If it did, Dr. George noted, there’s a chance that chemotherapy won’t be as effective the second time around. So the next step is the consultation with the surgeon, Dr. Guru, on Friday. I have many questions.