In Our Days to Your Days (Part 2)

M. P. Vasudevan hails from a small village in Kannur district of Kerala state. After post-graduation in Zoology he worked on a research project at the University of Calicut that was aided by the Swiss Government. He joined the Central Board of Excise & Customs (CBEC) as a Preventive Officer through the Staff Selection Commission (SSC) exam. He started at Goa Customs in 1981 and was then sent to Mumbai Customs on deputation in 1988. He got his first promotion in 1996 and became Assistant Commissioner in 2014. He retired on superannuation in June 2015. Post-retirement he devotes most of his time to maintaining his website www.referencer.in which serves as a reference library for both tax officers and tax payers under Government of India.

[Editor's note: This is part two of Mr. Vasudevan's medical adventures. Read part one here.]

I do not know what had happened to me or how much commotion took place after I fell unconscious. When I opened my eyes, there were a lot of people standing around my bed. The duty doctor was checking my pulse. My mother was in tears, pleading with the doctor to save my life.

Apparently it was a hysteria attack. Consequently, my stay at the hospital became longer than expected. I had to take ‘Eskazine’ tablets regularly for nearly six months.

Till date I do not know how and why the hookworm disappeared without any trace!

Second day in ICCU ………..

I do not remember when I slipped into deep slumber or for how long I remained in slumber. It was around five or six in the morning when I woke up to the realities around me.

“Who is this beautiful lady with short hair and red dress waving hands at me,” I thought.

The red dress was amazingly marvellous in the midst of an all-white backdrop of the ICCU. She seemed to be coming towards my bed. I glanced at the monitor perched above and saw my heart beat jumping from 70 to 80 per minute (the display actually shows estimation depending on one or two heartbeats and not the actual number of beats).

“Oh! It’s my wife, an old lady, not that pretty too. Or was I just seeing things”, I corrected myself.

She had virtually infiltrated into the ICCU slipping through the two-tier security cordon of the Hospital. I saw the watchful Security Guard, sporting a smart uniform come into the ICCU searching for her. It seemed to me that the guard, not finding her in the specified visitor’s waiting area, had come inside the ICCU to check out if she had given him a slip and managed to enter ICCU.

The Guard could not find her in ICCU either as she had moved to a corner and away from my bed. I whispered to her to not to create a problem for the Guard and she should stay in the visitor’s bay outside of ICCU. The poor fellow may lose his job.

She agreed with my assessment left as soon as the security guard went away from the ICCU.

Doctors came on rounds regularly – morning and evening. Studied the reports of innumerable tests – from simple Blood counts to 2D Eco Cardiograms & Colour Doppler studies, hourly ECGs, Thyroid profile, Liver profile, Renal profile, Urine routine, Chest x-rays, Creatinine, Electrolytes, etc., etc., and asked questions. They then decided upon the further course of treatment – oral intake of 200mg Cordarone. I was discharged on the morning of the third day of hospitalisation with a pile of reports and a bag of medicines.

And Lots of goody goody advice.

Restarting of the heart……

I am sure most of you are familiar with the "Start" and "Restart" buttons on the computer operating windows operating system. I used to "Restart" my computer whenever it was non-responsive due to corrupted files or viruses. Now-a-days the mobile phones also have a "Restart" provision if it misbehaves or becomes non-responsive.

It happened on the 2nd of October 2015 to be precise. I had a palpitation (similar to the earlier episode) in the morning and had to be rushed to Dr L H Hiranandani Hospital. After the first incident I have been consulting the same cardiologist on a regular basis and was following up with tests, investigations and medication. I did not skip even a single dose of medication.

As usual, in the Casualty ward, I was with the attached Multi-Parameter Patient Monitor. I could see my heart beating at the rate of 160 to 170 per minute, way above the normal limits.

The Doctors were attending with care and an air of emergency as always prevailed. I was a bit cool as I had been through a more severe condition only a few months back. I was sure my heart will become normal pretty soon with intervention of the specialists.

"We are going to ‘restart’ your heart," one of the smart looking young doctors came near me and said.

I looked at him in disbelief.

"We will stop your heart and then restart it. It may start beating normally and you will be able to go home from here pretty soon", the doctor explained.

I became nervous since it was unknown to me that such a procedure even existed. But the young doctor seemed very confident. The required medicines were arranged immediately.

I was administered one drug ‘X’ to stop the heart. A second ampule ‘Y’ followed to flush out the earlier one and restart the heart. The drugs were injected intravenously on my left hand one after the other with a few seconds interval and my hand was slowly raised to facilitate its flow through the vein. I could feel as if millions of small ants were moving all over my body.

Yes, I could also see the cardiogram display going blank for a few seconds and then coming back. My heart has been "restarted". However, it did not bring any change in the heartbeat rate which was still showing 168.

The disappointed doctors decided to admit me in the ICCU once again.

This time around I stayed in the ICCU for one day and got shifted to the normal ward for another day. All the earlier tests and investigations were repeated during these two days. I was discharged on the third day afternoon with the advice to continue the Cordarone regimen. However, there was no categorical conclusion as to why the atrial fibrillation recurred while I was still on the drug Cordarone.

Follow up with the cardiologist continued every fortnight. During one such visit he suggested that I undergo angiography and further explore surgery or RF Ablation as a permanent cure. Cordarone had also started showing its ugly side effects interfering with the skin regeneration in the mouth, throat, alimentary canal, etc., causing continuous bleeding.

RF Ablation ………

I, thus, consulted another cardiologist who was one of the three cardiologists in India doing Radio Frequency Ablation procedure to treat such disorders. After two to three consultations the date for the RF Ablation was finalised to be on 22 January 2016.

The difference this time was that the hospital, Holy Family Hospital and Research Centre at Bandra, Mumbai was not a branded "Super Specialty Hospital".

It was an ordinary hospital run by a charitable trust, with mosaic floors, painted walls and low roofs and was in existence since 1942. They cater to patients from all strata of the society. No fancy show off facilities like that of the ‘Super Specialty Hospitals’ of today.

Holy Family Hospital and Research Centre, Mumbai.

Nevertheless, they treat humans and send them home hale and hearty. One can enjoy and feel human touch everywhere in the Holy Family Hospital. I enjoyed the homely food served, especially the lunch with fish curry. It was a planned two-day stay for the RF Ablation from the 22nd.

It was a pre-arranged programme of hospitalisation in contrast to the earlier two stints. Therefore, as a bonus, I had to have additional sleepless nights to visualise the happenings on the operation table. Many frightening filmi scenes were flashing through my mind throughout the night.

The RF Ablation procedure was to be conducted at around 1pm and the doctor had advised me to have breakfast at seven in the morning and reach the hospital at around 9am so that the stipulated minimum 6-hour starvation period was met. They also needed time for carrying out and one or two essential tests before the R AF procedure.

www.wikipedia.org says that Radio Frequency Ablation (RFA) is a medical procedure in which part of the electrical conduction system of the heart or other dysfunctional tissue is ablated using the heat generated from medium frequency alternating current. RFA is normally conducted under local anaesthesia. Radiofrequency energy is used in heart tissue to destroy abnormal electrical pathways that are contributing to a cardiac arrhythmia. It is used in recurrent Atrial Flutter (AFL), Atrial Fibrillation (AF), Supraventricular Tachycardia (SVT), Atrial Tachycardia (AT), Multifocal Atrial Tachycardia (MAT) and some types of Ventricular Arrhythmia (VA). The energy-emitting probe (electrode) is at the tip of a catheter, which is placed into the heart, usually through a vein. This catheter is called the ablator. The practitioner first "maps" an area of the heart to locate the abnormal electrical activity (electrophysiology study) before the responsible tissue is eliminated. Ablation is now the standard treatment for SVT and typical atrial flutter and the technique can be used in AF, either to block the atrioventricular node after implantation of a pacemaker or to block conduction within the left atrium, especially around the pulmonary veins.

Before proceeding for the RFA, a Stress Test and a Trans Oesophageal Echocardiography (TEE) had to be carried out to check the condition of the heart. I reached the hospital at the appointed time and got admitted after the initial formalities, filling forms and making deposits, etc. The hospital, though very old, established in 1942, was very neat and tidy. It had all the modern facilities. The staff was all cordial and helpful. I was admitted as an inpatient. In bed No. 407B, I waited for my turn.

Stress Test was the first one. Since I had undergone such tests twice before, there was no problem in completing the ten minutes’ test though I felt exhausted because of the fasting. However, the Trans Oesophageal Echocardiography (TEE) was not that smooth.

The worst part was swallowing the “snake like” probe to go right down into the oesophagus. Head of the probe containing the trans-receiver goes and sits very close to the heart to take three-dimensional pictures of the heart. It was really an extraordinary task though the neck gets a local anaesthesia.

My wife asked the doctor how much time it would take.

“It depends on how cooperative he is”, was the answer.

I realized what she meant later on. The local anaesthesia was a chemical spray right inside the throat. It has all the possible bad tastes on earth.

“Keep it for a while and then swallow”, the doctor said.

I felt that my throat had swollen and there was no opening left for swallowing even the spit. The spray was repeated thrice and the neck became so heavy. Then, it was the turn of the snake like probe to go in. It was covered with jelly. I was told to swallow it. You may have seen some roadside magicians swallowing live snakes or long knives.

It was really a very mind-numbing job. How to swallow when the whole throat is chocked? It was somehow pushed into the oesophagus. The monitor kept in front started getting signals. I could see my heart beating in the display. Monitoring and recording of the heart and nearby arteries and veins went on for some time. My doctor also came in for a close look at it and concluded that there was no blockage anywhere. The probe was removed and I was sent back to the ward.

Next process was to ‘shave neck to knee’. A male nurse came in with razors and shaved my body from neck to knee. The whole body looked clean like an ‘egg shell’.

I felt so uncomfortable to look at my body. It was already one o’clock and it was time for the RF ablation procedure. I was wheeled into the Cath Lab on the sixth floor through an automatic glass door, I was taken inside.

I was told to wear a pair of slippers, which was meant for inside use. I was made to sit on a plastic chair in the corridor. I could gather that I would have to wait for some time as the earlier patient’s RF procedure had taken abnormally long due to some unforeseen complications.

I looked around. I could see the doctors and nurses going in and out. The Cath Lab including the surroundings and corridors looked clean and heavily lit up. It was extremely cold too. May be the bacteria will not dare to come in such cold environment! Although one sympathetic nurse had brought and covered me with a heavy blanket, I was virtually shivering in the cold. Bitten by cold and shivering I waited for my turn worried whether my family outside was aware of the delay.

The real fun next …………

I could not guess how much time I have been waiting there.

“What is the time, sister?” I asked a nurse passing by.

“It is 4 o’clock”, she said.

“Oh, I can’t even make out what’s the time, is it day or night, or where I am”, I said to myself.

I saw the doctor coming out of the Cath Lab telling the nurse to give me a bed to lie down upon. I was offered a gurney.

The flood lit room adjacent to the Cath Lab was a deceptive place altogether. Oblivious of the bustling city and crowd outside, I tried to close my eyes. A little later, I saw the earlier patient being shifted out of the Cath Lab, which reminded me that my turn was next. I was taken inside the Cath Lab, a 30x30 feet room, dimly lit but dotted many ceiling LED spotlights.

I was made to lie down on the operation table placed somewhere in the middle of the room. A male nurse came and removed my pyjama. I was with my shirt only. I naturally felt shy, as there were five-six hospital staff around including female nurses around.

“Oh, it’s a routine for them”, I consoled myself.

One nurse covered my legs and chest with a piece of cloth. A long cloth with four holes was placed over it. I was now completely wrapped in a brownish red cloth exposing very little of my chest and legs.

A metallic plate was kept below my chest, which perhaps reflects the rays coming from the huge overhead scanner, looking just like an x-ray machine, hanging right above me.

One absorbent pad was also placed below the hip for absorbing the blood flowing out. I was then connected to the monitor showing the heartbeat, blood pressure and oxygen levels. Intravenous saline drips connected. All these preparations were going on with robotic precision with each nurse and technician doing the assigned job without any prompting.

Suddenly the lights came on blinding me completely. I could not lookup since the lights were so bright and I felt like looking at the sun directly.

One Assistant came with some local anaesthesia, needles and catheters. The main artery supplying blood to the legs, the iliac artery and the vein going out of the leg, the iliac vein on both the legs were punched near the groin area and four over-the-needle-catheters were fixed.

Through these flexible wires with electrodes at their tips were inserted. The head of the main scanner hanging above me moved – it moves towards left and right, two widescreen monitors connected to it came to life showing the electrodes while they passed through the arteries and veins.

The doctor and the technicians were at their positions. I recollected the doctor explaining the procedure at his clinic, saying that the procedure would try to simulate the palpitation, locate the rogue nerve and then destroy it.

A second simulation would be done to confirm whether the ablation was a success. The first few minutes went on trying to stimulate the suspected nerve to start the palpitation. It was not successful. The doctor changed course. Giving it up, he started the main procedure.

In the Cath Lab’s pin-drop silence the Doctor’s voice echoed, “I am at 1-2”.

The technician answered in response in intervals, “15 degrees 5 seconds, 15 degrees 10 seconds, 15 degrees 15 seconds, 15 degrees 20 seconds, 15 degrees 25 seconds”.

At this, I felt a scorching pain in the chest and cried out ‘aaa’ loudly. A burning pain flashed upto the back of the brain like a lightning. Yes, that problem nerve was gone - burned down!

The doctor turned to me and said sorry. Similar sequences continued with 20, 30, 40, 50 degrees with a charge of 5, 10, 15, 20, 25 seconds duration at various points like 13-14, 23-24, 26-27, etc.

In short, the doctor was positioning the electrodes and the technician was switching on the radio waves in various prefixed strengths and duration to ablate, to burn the tissue including the nerves between the two electrodes.

I was naturally scared to watch the monitors showing the electrodes dancing inside my chest. Instead I chose to concentrate on a small monitor on my left, which was displaying the cardiogram, pressure, oxygen level, etc.

At one point, I noticed the blood pressure slipping down. I looked at the doctor but he was busy at his work. I closed my eyes feeling scared of the consequences. Actually, a thought of many filmy scenes of casualty made me more scared. I felt it would be better to go through such procedures under general anaesthesia to avoid such frightening thoughts.

Fun filled moments ……………

The procedure was going on and the doctor was fully engrossed in it. My right hand was stuck in the plastic sheet, which was covering the bed. It was a bit irritating. I have been trying to get it released but could not.

However, I continued to apply more and more pressure. Suddenly it got free with a jerk. The doctor, immersed in his work, was shocked, as he could not guess what had happened.

“Why you moved, why you moved?” the doctor got wild.

I just kept mum and he continued with his job.

Next it was the turn of the nurse. No nurse was around when some equipment was called for.

“I cannot work with these junior people, I want some seniors,” the doctor shouted two, three times.

I also saw him bringing one nurse from outside and giving her a few sit-ups as punishment. She was told to be at my side to console when I cried in pain but she had disappeared!

I just remembered such punishments I got during my school days – no reporting, no enquiries, and no written orders. I controlled my laughter recollecting the earlier incident of my hand jerk inviting the doctor’s wrath.

Yet another nurse got more scolding for mis-reporting also. She had earlier informed the doctor that wife of the next patient in queue was agitating outside since his operation was delayed.

The doctor had instructed her to get the junior doctor to explain the delay and to bring the patient inside. After sometime, the doctor asked about the patient and she said he was already inside. However, later the doctor came to know that the patient was in the ward and his wife was still agitating. I enjoyed all the side show much more than the procedure going on inside my chest.

After about one and a half hours, the doctor declared the procedure to be over and left. Upon removal of the electrodes, I was wheeled out of the Cath Lab to the adjacent room for the post operational care. The removal of the needles and freeing me from the operation gears was still pending. All the senior nurses had left.

It was the turn of the junior nurse, Ms. Vaishnavi to do it. She started removing them one by one. The holes punched on the veins and arteries were not minute. They had to be clotted immediately to stop the bleeding. They were to be held pressed with great force to slowly get sealed.

The veins started bleeding as soon as she released the pressure from her fingers. One male nurse also came to help. After about half an hour of use of pressure on each of the cuts, the bleeding dropped to minimal.

The wounds were bandaged and sand bags of around one kilogram each were placed on them. Thus ended the procedure. I was wheeled out to my room where my wife was eagerly waiting.

The next day I was discharged.