When I was a boy, my grandad smoked a pipe. To clean it he used a pipe cleaner; around six inches of flexible wire encased in fluffy cotton. My sister and I would make intricate models out of them. Similar, larger pipe cleaners are used to clean sinks and drains. Whatever the size, pipe cleaners meet the challenge of clearing blockages in tubes with bends. As you push the cleaner through the pipe, it veers around the corners and dislodges unseen obstructions.
This is basically what an angioplasty does for the vessels providing blood to your heart muscles – and then some. The blockages are fatty deposits caused by high cholesterol which stop the vital blood flow. This can cause angina or a mild or serious heart attack. The pipe cleaner goes in through the wrist and reaches the heart, a distance of about two feet (or should that be one arm and a half arms).
That’s the textbook description. This week it all became rather personal. I had been admitted to the local cardiac hospital on Christmas Day after my chest pains when turned out to be a heart – and not a heartburn – issue.
Before the procedure, I was invited to go somewhere private and shave my wrists and my groin area using an electric shaver to minimise the risk of infection. The groin is second choice entry point in the event of a problem with the wrist. Not being sure which area of the groin to shave, I did a pretty thorough job of the whole downstairs region, only to find on inspection, that I’d missed the important square centimetre. The nurse cleared this up in 2 seconds. Points lost and ego deflated.
I had resisted the temptation to neaten up the stubble on my face at the same time. It’s always important to look good in the operating room, but I new deep down that wearing “that” gown, it was a lost cause.
You soon learn in hospital that your body is no longer your own. It has been contracted out to the NHS. They can extract blood, attach a cannula, wire it up to a monitor, feed it drugs, confine it to a bed, wake it up at 3am and much worse – and you have little say in the matter. Unless it’s a bit risky, in which case they wake it up at 3am and get it to sign a detailed disclaimer.
At the same time, we suspend all normal conventions of bodily exposure and privacy. Embarrassment and humiliation are accepted as part and parcel of the deal. So, I accepted the ridiculous gown and the shaving inspection without complaint or even embarrassment. I had already had a young nurse ask “to see my bottom” – apparently to check for bed sores. In for a penny.
I had been told I was 5th in line for my procedure that day, expected at 11am. My schoolboy error was to treat this time seriously and not to order lunch.
Mid-day came and went. A nice nurse found me some sandwiches and updated me on my position: “you are second in the queue, please be patient, your operation is important to us”.
It was 2pm when, dressed up in the aforementioned off-the-shoulder gown, I climbed into the chair and waved goodbye to my fellow-inmates. They assured me it was easy, and I would be coming back soon. I was not the 1 in 200 where something serious would go wrong. As I was wheeled away to my fate, these odds started to feel shorter and shorter.
I lay obediently on the table and meekly surrendered my body to the procedure. This is for your own good, I told it, like a parent sending its child to the dentist. To my left was the biggest digital screen I had ever seen. Inches above my head was an X-ray machine which swooped like a vulture in all directions.
To the right stood the surgeon surrounded by his team. He numbed my wrist and asked me to hold a handle, so that my right arm was in the correct position. From that point onwards I didn’t see anything and really didn’t feel that much either. Apart from anxiety.
The operation is a little more complex than my grandad’s pipe or my drain clearing. The network of blood vessels round the heart is like the roots of a plant, or a river delta – and there is no diagram to follow. The first thing they do is inject a dye into your blood so that the X-ray machine can map the blood vessels.
I felt a little discomfort as the catheter twisted up through the artery in my arm and a strange coldness when the dye was injected. I glanced at the silhouette diagram of my heart vessels on the screen. There was a quiet discussion in the room. Unnervingly, the only part I heard was “it’s a big one”.
With a catheter in my arm and an x-ray machine above my head, I was trapped. Combined with the thought of what was happening inside, and not helped by the obligatory Covid mask creeping up my nose, my anxiety was rising.
I thought of my wife, children and granddaughter and when I’d done that, I tried a bit of mindfulness, noticing every detail of everything I could see. The x-ray machine was made in 2014. There were 12 ceiling tiles. There was a wire in my body. I was hot and perspiring. The man who had wheeled me wiped my forehead with a cold flannel. I could have kissed him, if I could have moved.
The amazing part of the procedure is when they steer into the narrowed blood vessel, push through the blockage, inflate a small balloon to widen the artery and then accurately position and deposit a stent to keep it open. My flannel friend showed me a stent afterwards – it was like those springs you find when you dismantle a ball point pen, only about half the thickness.
The whole procedure is felt done by a guy watching the screen – like some giant computer game- but with rather real and lasting consequences. I had to admire him and his dexterity. I can’t even grab the cuddly pink bunny with that big grabber at the fairground.
I dared to move my head slightly – and saw what seemed to be spectators looking through the window. This was the senior consultant supervising. I could hear her instructions. “Up a bit, back a bit more, left a little”. I was waiting for “fire”, but all I heard was the occasional quiet click.
And then, the wire and catheter withdrew silently and exited the way they had entered. All done.
Before I left the consultant showed me the before and after X-ray. The one very feint line which was downstream from the blockage was now a fully fledged black line, full of blood. Mission accomplished.
I conveyed my (literally) heartfelt thanks – but they were already tidying up. Just another operation for them. Next please.
I was wheeled back to my bed. A couple of hours later, my body was discharged and returned to me. My drains were cleared and re-enforced, my mind was relieved and calmed. I was leaving for good with a goody bag of medicines to hopefully ensure I wouldn’t be returning any time soon.
And with a very thankful heart.