An Old Fart's Tale

AN OLD FART’S TALE

STEWART MARTIN

Chapter 1

This unexpected twist of fate began to unfold just over five years ago in November 2011. Lady Luck had to be smiling on me as my wife and I were at my doctor’s office in an older, somewhat rundown, part of Hong Kong, located close to the district of Shum Shui Po. My doctor is in his seventies, is extremely honest and straightforward. He hides nothing when giving you positive or negative test results and his opinion without any extra BS thrown in. He works seven days a week and more if necessary, doesn’t overcharge and clearly loves what he does. Just aren’t enough guys like him who aren’t pushing up daisies.

I was checking on my breathing and what had first appeared to be only minor aches and pains. My main complaint stemmed from rater brutal headaches shooting up the sides of my neck to my temples and then remaining for endless periods of time. I am not a very sound sleeper and really didn’t pay too much attention to it, but what the heck I would like to make it to my middle seventies and beyond, if possible. My mother was almost ninety when she passed away and I had heard a story about one of my late uncles who claimed to have made love to a woman every day of his life all the way into his late eighties. The story goes on to say that my uncle didn’t forget me in his will as he left me the two men who put him on and took him off. Sorry, these old worn out stories side track me every now and then and I will attempt to go back to reality. Unfortunately old people do want to talk to someone about anything, even if it doesn’t make any sense. I’m in that category.

Walking had become labored and I had to frequently stop to intake air and rest for a short spell. After all I am just past seventy and love to swim and don’t overeat or eat a lot of junk food, even with a weakness for cake and ice-cream. I don’t eat any visible fat and do eat plenty of vegetables, not a really professional diet but far from the worst and quite in tune with today’s recommendations.

After a thorough examination, my doctor told me I had very likely been walking around with a serious heart problem and insisted I enter a hospital immediately to run a few tests. The doctor had instructed his nurse to reach out to their pharmaceutical supplier, who within ten minutes or so delivered a nitroglycerin spray to be sprayed under the tongue if needed. He got on the phone to with the local hospital see what could be arranged while I went into the hallway with my wife to use the toilets.

Reality set in a few seconds later as I passed out in the hall. My doctor called for an ambulance that arrived within five minutes and my medical adventure was in full swing. This happened on a rather pleasant Sunday morning and not how my day had been planned, but as has been said millions of times before, ‘the best laid plans of mice and men often go astray’.

The common practice in Hong Kong is to go to a hospital closest to one’s home, but when an ambulance picks one up far from home, they take you to the nearest hospital which was almost around the corner from the doc’s office, called Catatonic Medical Center. This was a very clean, modern facility and appeared to be well staffed. Their emergency room was a triple ‘A’ act and I was attended to for at least forty-five minutes. They did one hell of a job keeping me ticking, but my blood pressure remained dangerously low at 70 over 42 and it didn’t look too good.

Life is a ‘bowl of cherries’ with a few pits thrown in to keep everyone aware that anything can happen to anyone at any time. I’m a bit embarrassed to admit that I have a great fear of hospitals. Imbedded deep in my mind as the thought that I would have rather have died than undergone any sort of an operation. Even in a clean environment one cannot help but hear the other patients moaning and groaning and so on. Hospitals have a unique special plan of giving you a sleeping pill and then waking you up as soon as you get into a relaxed mode to check your blood pressure, take blood, give you a shot or some oral medicine and that’s aside from the coughing, farting and genuine painful moaning emanating from other inmates. It is about as close to living hell as possible. I don’t know how you would react, but I was more than fearful, I was terrified. Now I’m not quite as dumb as a doornail and do realize that hospital doctors and staff do more good than harm, but my mind still rejects the thought of being in one or potentially being the target of some surgeon, whose only excuse is ‘oops’.

For some unknown reason, the Chief of Catatonic Heart Department, didn’t really believe me or his assistants or just didn’t like ‘Gweilos’, a name that Caucasians are known as and as far as I am aware means, ‘ghosts’, being used at times for anyone who isn’t Chinese. But then again I can be a real pain in the butt. He was additionally annoyed that I hadn’t gone through the usual channels via my own neighborhood hospital as this may have caused him to seem uninterested and slow acting. We did not hit it off as a doctor and patient should.

He eventually convinced me to take a gigantic bomb of medicine that looked like a grenade from WW1. It was indeed ‘catatonic’. He informed me it was used around the world and does at times knock out a blockage in a vein or artery, but is indeed dangerous, possibly causing some paralysis, skin discoloration changes and various and sundry other potential disasters, but only after I signed a bunch of consent forms. It was worth a shot if it avoided a surgical procedure. This cocktail, whose name I cannot remember, took over an hour to administer and several hours to begin to work its way into my system. It resulted in great discomfort causing severe skin discoloration from dark purple to brown and black, but after a few days began to slowly fade into the sunset. My left shoulder was to remain at least 4 cm larger than my right for roughly four weeks.

Without any apparent improvement in my condition, the doctor finally made an appointment for me to take a stent implantation test, although I had to go to the to the back of the line and wait almost four weeks as he did not consider me to be an emergency patient. I was on my best behavior trying to remain calm and hoping I didn’t simply fade away and die. I kept thinking about the old army quote, ‘hurry up and wait’. The hospital appeared to be very happy that I had decided to go home and wait my turn in line, but I certainly wasn’t mending and felt miserable at best.

Several days later I had another attack and wound up in my neighborhood hospital in Tseung Kwan O. This somehow managed to get me to the front of the line and two days later I was transferred to the Happy Health Hospital, (the name changed to protect the guilty), which was part and parcel of the King of Internal Plumbers Hospital, (the name changed to protect the innocent), where I had heard that most heart surgery took place. They were going to make a small arterial puncture in my groin area, send in a wire followed by dye to see what and where the actual problem was and if a balloon could clear the blockage and lastly put in stents to keep that part open. Since the United States Vice President Cheney, seemed to have such a procedure every few weeks, how bad could it be?

Well that’s where the rub is. The hospital and doctors are sued so often they over protect themselves in case something goes awry. Malpractice must be a thriving industry. The ‘legal-beagles’, and I do apologize to the handful of top draw professionals who always seem to manage to take care of the needy via pro-bono cases aside from their rather burdensome schedules), have outdone themselves. I offer the following, word for word, from the Happy Health Hospital, which was to be signed and witnessed or take a hike and do it yourself. If this doesn’t frighten you, nothing ever will. Without further ado I present to you the consent form I was given and leave it up to your imagination as to what you would do. For what it is worth, I was never asked to keep this confidential. This is what I had to consider before being tested for stent implantation.

Happy Health Hospital: Double Lucky Cardiac Medical Unit:

Guidelines for explanation to patients and their relatives on PICA+PTCS, STENTIG, LASER, ROTABLATOR, ARTHRECTOMY, THROMBECTOMY, ATHECTOMY. (Laser I barely understand, the rest I still have no idea).

Aim: To treat coronary artery narrowing by balloon dilatation and or stent implantation in order to relieve symptoms of coronary artery disease, e.g. angina, dyspnoea, etc. Long term prognosis may also be improved.

Procedure: It is performed under local anaesthesia, a small arterial puncture is made usually in the groin or arm. The procedure usually lasts about one hour but sometimes longer depending on the complexity of the lesions. After the procedure you are required to lie flat and monitored in the Coronary Care Unit overnight. Groin sheaths are usually removed when the blood thinners effect wear off on the same day or the day after. Bed rest is recommended for 12-24 hours. More than 1 session may be necessary to tackle the lesions for various reasons. You will be charged for the expense of disposable hardware used in the staged procedure.

Possible Complications (in additional to those of coronary angiography)

1. Emergency bypass surgery rate: 1-2%

2. Risk of suffering from a major heart attack: 3%

3. Failed procedure for various reasons.

4. Hypersensitivity to drugs.

5. Abrupt closure of the culprit vessels is 3-5%, may need to return to catheterization lab. Required redo procedure.

6. Coronary artery rupture: 1%

7. Abnormal heartbeats (Arrhythmia)

8. Bleeding requiring transfusion

9. Renal failure (Contract nephropathy)

10.Stroke: 0.3%

11.Acute and subacute stent thrombosis: 1% (which requires emergency re-intervention)

12.Re-narrowing rate (average about 15-20% within 6-9 months)

13.Mortality rate: 0.2-0.6%

Note: Please note that the above list is not exhaustive. The above list includes

the common and documented complications of the procedure but it is possible

that due to unforeseen circumstances other complications not mentioned in the

above list may occur, including serious complications. (not including being

operated on by a new internist).

Next is the prepayment requirements and before bringing that up; all I have to say is:

"Now I lay me down to sleep, with a bag of peanuts at my feet,

If I should die before I awake, you’ll know I had a bellyache!"

(Furthermore, I was clearly told by the hospital doctors that the newer Drug Eluting Stents were far better than regular plain stents which may need to be replaced within three to six months, whereas the new Drug stents last 3-5 years.)

Then reading onward, this statement is made: If patients choose to pay for some new devices such as Drug Eluting stents, which may contain clinical values, the Hospital Authority shall recover from patients basic costs……..(First they go out of their way to sell you the Drug Eluting stents, then they tell you they have only marginal values)…..What’s up Doc???

For the record: An average patient uses two to three stents and must put up a deposit of approximately HK$60,000 or roughly in USD$7,700. The policy is ‘pay first or die’. It’s actually very straight forward and to the point. I like people who don’t beat around the bush.

An additional list for Anesthesia and its problems which are extensive, is also available, but enough is enough. I simply wanted to tune you into my confusion and fears, for a very common procedure. My wife and I decided to go forward and play out the hand till the end. All the negative stuff considered, I could not go on in the condition I was in and so I flipped a coin to let fate decide, ‘heads they win, tails I lose’.

As things turned out they only got as far as pumping in the dye and then stopped the procedure, as they determined that plain or drug stents would have little or no effect. My heart was in such condition, that a triple bypass was called for and with little time to lose, I again opted to move onward, that is let them have all the fun and if I wound up in heaven or down with my old buddy the devil, my choices were extremely limited. Besides, they had a guy ready to do the bypass as he didn’t feel like playing golf.

Surely, I was born under a lucky star as my life was first saved by the emergency room doctors at Caritas Hospital and then slowly recovered from four days of groggy, drug induced sleep to hear about my five hours of surgery. A few days later the plumber told me I had died twice during the operation. Strange, I don’t remember any bright lights, any weird people or monsters during my visit to the other side, a bit disappointing after all I’ve heard and read about the subject. (However, I did come back with a three foot tail and need to polish it every few days.) The truth is we have enough weird people and monsters already here in plain sight.

The intensive care unit at King of Internal Plumbers Hospital took excellent care of me for the next two weeks and then decided I had overstayed my stay and kicked my butt over to their rehabilitation center at the Happy Health Hospital to prepare me to rejoin the real world at large, also known as everyday life.

Hong Kong picked up the entire tab and even refunded the deposit made prior to my balloon stent adventure. Without their kindness and skills I wouldn’t be here to tell the rest of my tale. My hat is off to all of them. I’m so pleased not to have been forced to sweep the streets to repay the Hospital Authority or to have likely been living in the streets of this wonderful city.

I cannot honestly say that the Happy Health Hospital’s rehabilitation facility was as well laid out or as clean as the intensive care unit of the King of Internal Plumbers Hospital. However, considering all of the amazing procedures and care given to me up to that point, I was there to physically recover my strength and mentally aware this wasn’t a country club or a hotel. One thing remained constant, the food was horrible, we were offered hot cereal for breakfast or congee for supper and then reversed the next day, both equally tasteless. Thanks to my wife I had plenty of fresh fruit and didn’t starve. Let’s face it, hospitals aren’t vacation spas and normally want to get rid of you as much as you want to get away from them. I did manage to lose twenty pounds of unnecessary weight, (without cutting off my head), between the operation and the yucky food.

Directly across from my cubicle was a Cantonese guy who seemed to be in his forties. He had talked with my wife prior to my operation and filled her in with a lot of details. He was very pleasant and went out of his way to make the whole thing seem like a cake walk. I have taken the liberty of calling him Hi Fi and he was constantly being attended to by his wife and young daughter and obviously in a lot of excruciating pain. He was waiting for a heart transplant. To the left of Hi Fi’s bed was a short five by five obese woman in her seventies or eighties and totally incomprehensible. She looked and acted as if she had been deposited in her cubicle as if by accident. I thought of her as the Lump. At that moment no one else was in the bed on my left. Various people occupied the beds within their curtained cubicles.

Chapter 2

The doctor in charge of the rehab center had an appointment with my wife to discuss my case. I wanted to hear what he