Returning Home

I’m home, and it was a bit of a surprise that it happened.

What’s really odd about it all is that to the patient there doesn’t seem to be a process for agreeing the final day, it just sort of all comes together. It did for me on Sunday morning and although it took a little questioning and a few special moments with a nurse, I made it home.

Stranger than the process of getting here is being here. The feeling that I’m back at home where I was less than a week ago before the operation but now with a wonderful new, lifesaving heart valve installed.

Soon after the operation it was said how well my progress was and that it might mean an early trip home, this was early on, even before I hit Atrial Fibrillation. Let me just explain that one again before I go on. From the NHS website:

Atrial fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate.
A normal heart rate should be regular and between 60 and 100 beats a minute when you’re resting.

In atrial fibrillation, the heart rate is irregular and can sometimes be very fast. In some cases, it can be considerably higher than 100 beats a minute.

This can cause problems including dizziness, shortness of breath and tiredness. You may be aware of noticeable heart palpitations, where your heart feels like it’s pounding, fluttering or beating irregularly, often for a few seconds or, in some cases, a few minutes.

There you go, the definition of what I had for three days, almost two days irregular and the rest just high. In fact I’m still on the AF correction medication and have some more time to go.

However, this wasn’t about AF. The point was that even before the AF arrived Sunday was being discussed as a going home time. That never seemed to change even with the appearance of AF. When I say discussed I mean the doctors had mentioned that if all goes well I could be going home, so it was never a hard and fast you will statement.

After that it wasn’t really mentioned by the doctors again. I mentioned it a couple of times, to nurses who asked if I had a date for going home, and to other patients wanting to compare their progress.

Coming up to Sunday no-one was entirely sure what was happening, and to make things more complicated it had been said that if I couldn’t move my bowels then I wouldn’t be allowed home. I asked again on Saturday evening about the sticking point and there still wasn’t a definite answer.

So I tried. I really did. On Saturday I had double doses of laxatives and nothing happened. Overnight Nurse R. offered me suppositories, however I was nervous about the idea, obviously! Since it wasn’t certain I wouldn’t be let home without doing the business I decided to leave it as a last resort. I was putting it down to performance anxiety, not having eaten much until the day before when I took my first full meals, and the high turnover for toilet time – I don’t know about you but I’m a contemplator and I can be in for a wee while having a think or a read waiting for my body in its own good time, that doesn’t work in a ward.

Sunday came, and still no one was sure about being let out, but I was saying that the doctors had been talking about letting me out later that day, so the nurses prepared. They took off my dressing, removed my stitches (and dressed me up again when one of the wounds bled a little), prepared my medication and got everything into place, waiting for the doctors to do their rounds.

Then an emergency came and it transpired that there would be no consultant to go round the patients. So I thought it was all over. That is until a wonderfully mannered lady doctor came round with what I’d guess would be called the ward doctor, and reviewed my case. They asked me when I’d like to get out, today or tomorrow, and I obviously said today was preferable, but I could wait if they wanted me to.

She was decided. Suppositories it was. Well I won’t go into that experience, although it’s nowhere as bad as you might think, just hugely embarrassing when the whole ward knows what’s happening. However it was the fact that it was so up in the air whether I would go home that day, even after that moment.

Drugs in. Results soon after. I was clear to go. A quick DVD watched, some letters typed for my GP, a drug bag walk through, an information pack, and that was me ready.

All the while the nurses were going about their normal business and the guys in the ward were just leaving me to it, with the odd good luck message thrown in.

It was the strangest process though, and it did feel as though I pushed the whole thing after they’d planted the seed in my head some four days beforehand.

Leaving was a strange affair too. My wife came up to drop off a big tub of sweets for the nurses. I handed it over to the only one of them that was at the desk at the time, since the rest of them were off on other wards, and there were goodbyes and good luck wishes to the guys in my ward. I did get to say bye to another nurse who wheeled me downstairs, all very strange. After being so closely looked after by them all it seemed to be odd to just be left to walk away without much fuss.

Actually coming home has been a rather strange emotional experience too. Standing around the house, or rather sitting or lying, and doing a few of the things I used to do puts it all into perspective, mainly just how hard it is and just how much help and assistance the hospital and the routine were giving me.

Getting in and out of a fixed bed with a fixed height is suddenly a huge challenge, just for one thing. The comparisons are easily made to pre-op when you’re home as you try and do things you’ve done before, or just be in similar circumstances. Anything from making a cup of tea to moving to the living room hammers home to you just how immobile and restricted you are now.

There’s also the effect of your mirrors. I am constantly catching a look at myself, and especially the scar, and feeling that punch reminder that I’ve just been through major heart surgery. When you’re away from that mirror you’re getting on with normal life again, even if it is severely restricted, but walk in front of a mirror and wham – there it is.

Emotionally there’s time to reflect and consider what’s happened to you, as well as what could have happened. Before I was away in a separate environment, a special one created for this entire situation and allowing you to compartmentalise everything. Here I’m back at my own home, where I can do my own things that I’ve always done to the same old routine. All fantastic, but it does bring it back to you and twice now I’ve been in tears, and at the same time pain, because of the reality of what has happened, what could have happened, and what my wife has been through while I was in hospital.

Practically there are issues too. My wife is now replacing a team of highly trained nurses, a huge act to follow believe me, and let’s not think about the emotional pressure she’s applying to herself over how to look after me, what’s too much, when to step in and when to stand back, etc.

We called the GP Doctor this morning as discussed with the Hospital Doctor, and discovered that the GP should have been told prior to us coming out of hospital to arrange a home visit in order to take blood for the INR tests, they hadn’t. So, after much scrambling around on their part to try and find the Domestic Phlebotomist and add us into their diary for a visit, we decided to go round and see them – we’d already booked an appointment with the nurse just in case.

They took the blood and revealed that the results would be known next day and we could get them by phone, and that in the meantime I should stick to the dosage of Warfarin I was on. Testing would also be weekly rather than daily which struck me as odd for being just out as adjustments would take a week to process – take a test, if my results are showing a drop or rise in my INR then I could start taking more or less Warfarin through that week, then take another test, see if the previous week’s change had been right, too much, too little, and adjust the dose accordingly again. It all seemed too long a time to be playing around with levels in someone who has just had the mechanical valve implanted less than a week ago.

For your mental records, INR is the International Normalized Ratio of what is known as the Prothrombin Time (PT). Basically it’s a ratio to show how your blood clotting compares to the standard ratio across everyone. There, you learn something new every day.

All in all the process of coming home has been an emotional one, a tiring one, and the transition far from smooth. Still, we’re here and we’re making it work. The next step will be starting to exercise.

In the meantime, if you want to see how that scar is progressing, have a look at my Chest Scar tag on Flickr, here’s a week after:

Surgery Scar Day Seven

That’ll keep getting updated day by day, or at least when there are progressions. It’s a beauty isn’t it?

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