Week 19

The countdown began in earnest last Tuesday, May 26. I took the last blood thinners before discontinuing them in advance of the surgery, which is next Wednesday, June 3, at Roswell Park Cancer Institute. OK, platelets, time to thicken up.

          I’m good to go. The pre-op examinations a week ago, last Friday, at Roswell Park confirmed it. A stoma nurse looked me over and marked an X on my stomach, just above the navel and to the right. The anethesiologist thought everything was OK. An EKG and a blood test showed nothing to worry about. And the surgeon, Dr. Khurshid Guru, the man who brought robotic surgery to Roswell Park, seemed satisfied that everything was in order.

          The major questions about the surgery were answered at the previous pre-op meeting with Dr. Guru, right before my heart problems showed up. The only surprise, to me, was his suggestion now that my hospital stay might be 10 days. Previously, I’d been told it would be six to eight days. One thing they’ll want to see is how soon I’ll be able to poop.

As for the surgery itself, most of the info I already knew. It’s going to last six hours. The bladder, prostate and a couple lymph nodes will be removed. A section of my small intestine, a piece of the ilium, will be transported, blood vessels and all, to hook up with my kidneys and serve as a reservoir which will drain through the stoma to an external pouch. Oh yes, and there will be stents helping to keep things open. My assignment – drink plenty of fluids to maintain the flow.

What did Dr. Guru think of the neo-bladder, the all-internal alternative about which my sister-in-law in Arizona had forwarded an Internet link. It’s a longer surgery and a longer recovery, he said, and it’s more appropriate for a younger patient. It takes a bigger piece of the intestine, which still wants to act like an intestine instead of a bladder, and then there are complications involved in making it all work. One fine day, I keep thinking, they’ll make new bladders with 3D printers, but that day isn’t here yet.

Meanwhile, health proxy Bill Finkelstein pressed one of his major complaints – being promised return phone calls and not getting them earlier this month when he wanted to find out the new date for the surgery so he could make arrangements to be there at the hospital. Dr. Guru explained that since the schedule was full, it was hard to find a time, but conceded that callbacks should have been made. My significant other, Monica Neuwirt, who also was there in that little examination room, contended that this was not the kind of thing that Dr. Guru should be concerned with. Well, yes and no. Does everybody have these problems?

Week 18, Day 6

   Now when people ask how I feel, I tell them, "My cardiologist says I'm fine." And if he thinks I'm OK, then I'm OK. 

   I talked with my cardiologist, Dr. Edward Spangenthal, on Monday after an EKG and after questioning by his nurse Dawn and stethoscope listens by him and his assistant Evelyn. The twinges I've been feeling in my chest, he said, are nothing to worry about. The EKG was good. The heart sounded good. A blood enzyme test turned up nothing. 

   So twinges and all, I should stop worrying. Heart-wise, I'm good to go for surgery the following week, on Wednesday, June 3. I'll find out all about it Friday at the pre-op get-together with the surgeon, Dr. Guru. 

   The entire visit at Roswell Park Cancer Institute was unexpectedly quick and easy, less than an hour. I barely got to crack open my New Yorker magazine before I was called in for the EKG. The hard part was setting up the appointment.

   Health proxy Bill Finkelstein started calling Dr. Spangenthal's office at Buffalo Medical Group at 8:30 a.m. Monday, sat on hold for 45 minutes twice, then got through just to be told that he sees patients at Roswell Park only on Mondays and Thursdays and his schedule was full. 

   But then Bill did an end run -- a conference call to Amey, the assistant to Dr. William Morris, the man who inserted the stents in my heart. She heard about my twinges, made a call, then got back to us. Get to Roswell Park as soon as you can, she said. By any means necessary, as Spike Lee puts it at the end of his movies. Sho nuff.

Weeks 17 & 18

Suddenly I’m thrown back to the big question that taunted me in the middle of the chemo treatments a couple months ago – how active can I be? Only this time, the limiting factor isn’t fatigue from the chemo. It’s those newly-installed stents in my heart.

          Not that I hadn’t been advised to take it easy, but I felt good after getting the stents. So last Sunday, Mother’s Day, two weeks minus a day after the stents, the lawn needed mowing. It’s never seemed like heavy exercise. I figured it wouldn’t hurt as long as I beat the height of the 80-degree heat and the sun by going out at 10 a.m. By the time I finished some 45 minutes later, I knew it was too much.

          Since then, I’ve felt on-and-off pains and tingles. A call to the cardiologist’s nurse on Monday prompted two pieces of advice: 1. Don’t do that again and 2. If you feel bad, go straight to the emergency room at Buffalo General Hospital. So on Thursday health care proxy Bill Finkelstein also did extra duty as my lawn mowing proxy.

          But the heart thing has become much more worrisome than the cancer thing. The cancer is treatable and predictable. It’s causing a major change in my life and it certainly could snuff me out, but it shouldn’t. The heart, on the other hand, could turn on me at any minute and kiss my butt goodbye. That’s what happened to my cousin Marsha, my mother’s brother’s daughter. She died suddenly Wednesday of a heart attack in Florida at the age of 62.

          Meanwhile, I’ve been playing bridge by day and working by night. Today, Friday, the bridge was a regional tournament in Rochester, an hour’s drive away on the Thruway. At least at bridge, I told a friend, there are retired medical professionals in the room. What if you get stricken while you’re driving, he asked. Guess I’ll just have to pull over, I said. Sudden thought – better not put the car on cruise control. 

Week 16, Day 6

Post-stent checkback Monday with cardiologist Dr. Edward Spangenthal is my first visit to Roswell Park Cancer Institute that lasts less than an hour. And now that spring is here in full flower, it’s the first visit where the cold air blows out from the main lobby instead of gusting inward.

There’s almost no wait before a nurse takes my blood pressure and pulse, well within the normal range, and assesses my blood oxygen – 99 percent, up from pre-stent levels. Another nurse listens to my chest with a stethoscope and asks questions about medications and side effects.

Then Dr. S. himself steps in, does his own stethoscope tour, and says that things are good. He wants to keep me on blood thinners for three more weeks while the stents heal in, then go off them for a week prior to the bladder surgery. I’d resume them later when the urology surgeon, Dr. Guru, gives the green light.

That puts my big date sometime in early June, exact time TBA. We get to speak a little later with one of Dr. Guru’s assistants, who says that he does surgery on Mondays, Tuesdays and sometimes Wednesdays. Earliest date, then, would be June 1. 

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.