2022 started with great expectations. A two year Covid reign was slowly being put to eternal rest. Or so we thought? For soon there came a resurgence in a new avatar called Omicron. But mind you, the new virus was touted as kinder than its predecessors. Having dodged the virus's scarier seniors, we thought surmounting Omicron would be a child’s play. We had to just be careful enough, avoiding the nuisance of a home quarantine if we engaged him in our body.
The city of Chennai looked desperate to revive its upbeat mood. The rains were casting their incessant spell, though. Some areas got flooded, but our site, Defence Colony, was spared this time, unlike the 2015 deluge. That was no surprise because, for the record, the 2015 floods were not a natural disaster. We thanked Mother Nature for her blessings and moved on.
Soon after new-year celebrations, I went to my aunt’s place for a couple of days, mainly to help her recuperate post a cataract surgery. Kumar, my husband, drove me down to her house in the evening before the scheduled eye operation that was slated for the following morning. She was ready with her lovely dinner, being a fabulous person who always pampered her guests with treats. But my husband had set his mind on something different offered at a restaurant near her house. He tried enticing me to join him there for dinner. I refused for the first time that night, not wanting to disappoint my aunt and miss out on her treats, and instead tried to persuade him to drop the whimsical idea and join me at my aunt’s dinner table. But if you know my husband, you will understand that there is no turning him around once he makes up his mind on food.
The cataract surgery went well, and I returned home in two days and back to our office where I work with my husband. All went well until the eighth of January until he complained of mild throat irritation on a fine mid-morning at work. Deciding to head home, we reached by noon and had our lunch together, after which he wisely isolated himself. The symptoms quietly aggravated in the form of fever and mild cough. He ate well for the first three days like an obedient kid, but soon his consumption went down. The fever raised its head every evening, and the temperature sobered after a paracetamol. It played on for eight days when he decided enough, and it was better to check himself into a hospital. Although I intuitively felt it was unnecessary as his Oxygen levels were normal, I didn’t dare say a word because I trusted that the patient was the best judge in such situations. Intravenous Remdesvir was administered for five days, and he came home fully recovered but with a slight post-Covid fatigue. In the meantime, Omicron swiftly checked into the rest of the family’s bodies and thankfully departed without causing much damage. I must add that the Chennai Corporation was of great support during the period, frequently enquiring about our temperature and oxygen levels besides offering help for purchasing groceries.
A week went by resting. Soon Kumar resumed his morning walks, and life was sliding back to its old routine. But in week two, he sensed a weird burning in the chest during morning walks. It would subside every time he stilled himself only to return when he walked again briskly. If it didn’t feel worrisome, it didn’t seem alright either. Toying with consulting a cardiologist, he spoke to a few of his friends in the medical field. He was advised to take an angiogram bypassing the treadmill test given his stated symptoms. We checked into another hospital for the diagnostic process.
The angiogram showed two 99 percent blocks at LAD (Left Anterior Descending) and PDA (Posterior Descending Artery). The report indicated that an earlier stenting in 2014 allowed reasonably good blood flow, but the stubborn new block stood just before it, making the stent useless. Further stenting was not recommended, and bypass surgery was considered the best option in the given scenario. Becoming a diabetic only recently with sugar and BP under control, blocks in arteries were a big surprise, revealed the doctors. Well, Covid can precipitate many things untoward in our physiology--it became the best logical surmise. We had to accept it and move forward. The bypass procedure was fixed for the following week—within five days.
We consulted friends who had undergone a bypass, and they gave us a detailed and encouraging feedback wishing the very best for us. Several doctor friends too advised bypass surgery as the best procedure of the present times and reassured us that it was a cakewalk for cardiovascular surgeons with years of experience behind them. The success rate was indeed high. Only an extended period of patient recuperation was bothering us, considering the entailed trauma of cutting open the chest to access the heart. But did we have a choice? We came home with a determination to set things at work before the procedure to facilitate an uninterrupted flow in our absence.
However, side by side, my husband was at something else. And I didn’t like the idea of anyone breaking my husband’s bones even if it were a well-intentioned doctor! But if it was the only option left, I had to command my heart to reconcile to the need for the durability of his heart. But somewhere, thankfully, Kumar had not reconciled himself to the developments, in a sense, he felt there had to be a better way. In the age of Google, you find easy access to plenty of alternatives for anything—real, fake, excellent or just ineffective. It is pretty scary.
But we cannot thank Google enough. The omnipresent, omnipotent encyclopaedia at our beck and call is a gift of the twentieth century to humanity. As I mentioned earlier, my husband was googling; and googling he was for alternative medical methods to address the blocks in his heart. Being an ardent fan of technology with a persistent itch to survey the latest gadgets on the planet, he had attended an introductory seminar on the use of robotics in surgery at least seven years ago at the Hilton. He had even tried his hands at the demo piece there. I was to go with him but stayed back due to my daughter’s exams then. Today, using the very same Da Vinci robot, there exists a Minimally Invasive Cardiac Surgery or MICS in the world performed only by very few trained doctors. It was an exciting piece of information requiring further study, but we hadn’t much time on our hands as the countdown to the scheduled surgery date had already begun. We spent almost the next 24 hours tracking every piece of information on the subject. Fascinated and convinced, we were mentally prepared to fly to any place, even Timbuktu, if the new procedure had stabilized over there with encouraging reviews and testimonials.
Fortunately, we didn’t have to look very far with google’s help and not even travel that far. It was available right here, in the city of Chennai at Apollo Hospitals, and the godman to chase was Dr MM Yusuf. We went through his profile on the net and watched his interviews and videos of the procedure and of other doctors worldwide. We were getting more and more convinced in our heads about this magical option. What was left was a consultation with the doctor himself that would clear any doubts and confirm the patient’s eligibility for the procedure. We fixed the appointment and met him two days before the scheduled conventional bypass procedure.
Dr Yusuf patiently explained to us the entire procedure. He also played the angiogram CD showing the locations of the blocks, which made it very clear to us. We could decipher from the foggy greyish-black and white video of heart physiology for the first time. He told us that a short horizontal incision of three to four inches would be made between the two rib cages nearest to the block which required the bypass graft. The whole day was spent at Apollo waiting for the busy doctor and running some mandatory tests after that. Fortunately, we got the eligibility green signal by the end of the day. If the breast bone need not be cut open, it could make a massive difference to the patient. That alone qualified as great news, and we could safely say we were not opposed to the robotic technique if crewless rockets could enter space and complete a mission.
We came back satisfied with the alternative. There was one concern, though. All our well-wishing doctor friends were not able to out-and-out recommend the new procedure that had its inherent risks vis-a-vis conventional bypass; the latter one was a tried and tested model the world over for donkey’s years, according to them. And the data on patient recovery was encouraging, even astounding. With due respect to their valuable advice, we remained low-key until the procedure was over, having made up our mind.
Robotic surgery was a new domain dependent on the performance of the automated equipment and skills of primarily young doctors who have undergone training for such procedures. But our gut feelings confidently led us to the new path of treatment, with built-in apprehensions that were difficult to shed completely. The doctor fixed a date a week later as he was busy doing at least two procedures a day. It gave us some more time to WFH and set things in better shape at the office, praying, of course, there would be no shocking symptoms to encounter for Kumar during the period.
We checked into Apollo the following Saturday, with surgery scheduled as Monday morning. The time taken was almost the same as a conventional Bypass, around six hours, but incisions were minimal and trauma far less. The rib cage was spared. A four-inch horizontal incision below the left nipple and three additional tiny cuts at suitable locations on the chest to insert a probe and maneuver the robotic arms were necessary. The LIMA (Left Internal Mammary Artery) for LAD graft and an artery from the left hand for the PDA bypass graft made their honourable sacrifice for the revascularization of the heart. The hand artery played tough before relenting in the extraction process, said the doctors post-surgery, and hence there was a delay by an extra hour.
With minimal hospital stay, about four days, the patient was able to walk home. He was asked to walk around the house and climb stairs every waking hour. We prayed that the post-operative period would transition as smoothly as did the surgery. Going one step at a time seemed prudent. The disappearance of symptoms in due course will further lift the patient’s confidence, and resuming work quickly in just three to four weeks will make life a fairy tale once again.
The purpose of this story is to apprise everyone of alternate MICS when confronting heart issues. This procedure is certainly more expensive than a conventional bypass, but the time saved and the pain spared is worth it, provided you are in good hands. After three months, both techniques converge for a patient to give the same results. The difference is only in the method and the first three months aftercare.
Technology can disrupt a lot of things in any field. Opting for MICS robotically-assisted surgery felt like going against the grain for us in many ways. But we plunged into it after a thorough understanding as discerning laymen and faith in our doctor.
Thanking Dr Yusuf and all the assistant doctors, our doctor friends for their advice and expertise; Rotarians and relatives for their constant support (that included blood donations) and our constant prayers we are now back to smiling again, rejoicing in the valid philosophy of “all’s well that ends well.”
PS: We can never forget the support and guidance from Dr Rajeev Durai, Dr Sriram, Dr Venu Gopal (my maternal uncle), Dr Lakshmi Ilangumaran, Dr Ajit Mullasari, Rtn Jaishankar Unnithan, Rtn Bhavesh, Rtn Shankar Duraiswami and many more Rotarians.
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