Issue 44 - From the Heart

Hello everybody. Welcome to Issue 44 of Deep Life Reflections, the first of 2024.

I had to take some time off during the past few weeks for health reasons. On December 19, I underwent open-heart surgery to replace my mitral valve with a mechanical one. I spent five days in intensive care and nine days in hospital overall. I’ve been at home recovering during the past three weeks. 

It’s only been the last few days that I’ve started writing again. The surgery and the recovery have been challenging, but I’ve felt better this past week. I wanted to re-start Deep Life Reflections today because it’s exactly one month since the surgery. I thought I’d take a slightly different approach to the format this week by reflecting on my experience over the past month. It’s still a Friday Five, but a different one; one that allows me to express my thoughts after such an intense experience. Maybe there is something of value for you, too. 

This has been a journey I’m grateful to have come through.

I’d like to share it with you. 

James

The photo below was taken the day after my surgery, on Day 1.

1. The Diagnosis

“Life is not the way it's supposed to be, it's the way it is. The way you cope with it is what makes the difference.”

— Virginia Satir

In late November, a few days before my 48th birthday, doctors diagnosed me with severe mitral valve regurgitation—a badly leaking heart valve. I’d had two cases of atrial fibrillation (an irregular heart rhythm) in the prior eighteen months and my valve deteriorated rapidly from mild to moderate to severe in a short space of time.

My valve condition was first diagnosed in 2019 during an annual physical. The valve condition was only mild and my cardiologist wasn’t concerned. He said they would monitor annually and I should continue with all my activities as normal. As a marathon runner, I led a very active and healthy lifestyle. I was a non-smoker, drank very little alcohol, maintained a balanced and nutritious diet, and trained six days a week. With this lifestyle, I hoped my valve condition would remain mild throughout my life, as it does for many others diagnosed with the same condition. However, that wasn’t the case.

When I learned the condition had progressed to severe after several tests and procedures to inspect the valve, I decided to have the recommended surgery. I was now working with three expert cardiologists in Dubai and they all said the same thing: the condition will only get worse without treatment. And worse could be fatal. I’ve always felt that when there’s a problem, the best solution is to face it head-on and get it fixed. The surgeon scheduled the open-heart surgery for Tuesday, December 19.

As I live in the United Arab Emirates, about 3,000 miles from my home country (U.K.), and my family couldn't be with me physically, one of the most important things I did before the surgery was create a WhatsApp group for my family and close friends. Those messages and calls really helped me get through those five tough days in intensive care—together with the friends in Dubai who came to visit me in intensive care, then the hospital ward. To date, around 30 people have visited me either in hospital or at home and I couldn’t be more appreciative. Every visit was a boost and highlight to my day. I’ve also received hundreds of messages from people wishing me a full recovery. I’ve been touched by every message.

2. The Surgery

“What matters most is how you walk through the fire.”

— Charles Bukowski

My surgery took place at Mediclinic City Hospital in Dubai, an excellent hospital with a renowned cardiology department. My surgeon was Dr. Preshun Chetty, a highly skilled and experienced cardiothoracic surgeon from South Africa. Prior to the surgery, he took over an hour explaining the full process and gave me his personal number in case I had any additional questions. Dr. Chetty’s plan was to repair the valve if it was possible to do so. Plan B was to replace it with a mechanical valve if it was beyond repair. I chose the mechanical valve option because they typically last a lifetime. A prosthetic valve, by contrast, usually needs replaced after 10-15 years. I didn’t like the idea of going through this again in my early sixties, so it felt like a straightforward decision, even though I would need to take blood thinners every day for the rest of my life with the mechanical valve. Life is full of pros and cons.

I checked into the hospital the day before the surgery. My good friend Stephen picked me up and dropped me off. I felt quite relaxed and slept well. It would be my last good night’s sleep for several weeks. At 5am the next morning, the nurse woke me to get ready for surgery, which was scheduled for 8am. I listened to a motivational playlist I’d put together, which included music from Christopher Nolan’s Interstellar and The Dark Knight Rises, plus the Training Montage from Rocky IV and the theme tune from the original Superman (which is why I wrote about Superman in Issue 43, the last issue before my surgery.)

Open-heart surgery today is routine, but it’s still a major operation and causes a lot of trauma to the body. I’ll explain it briefly and if you find this part uncomfortable, please skip the rest of this paragraph. The surgeon begins by making a six to eight-inch incision down the centre of the chest and opens it up. They cut the breastbone (known as a sternotomy) and open the rib cage to reach the heart. Next, the surgeon connects the heart to a heart-lung bypass machine. The surgeon stops the heart for 60-90 minutes to operate on it, while the machine takes over the heart’s pumping actions and moves blood away from it. Following the repair of the heart, the surgeon puts everything back in place and stitches the incision. The procedure takes around three to four hours.

It’s a pretty scary procedure. One of the mental preparation strategies I adopted before my surgery was developing a mantra: “This journey will make my heart stronger and my life even fuller.” I said this repeatedly, and also just before I went under the knife so my brain would keep processing it. Another thing I did was to smile as they wheeled me into the intimidating arena of the operating theatre. A friend of mine—also a heart surgeon—recommended I do this. He said, “the most important person on the day of heart surgery is you. You set the tone. You’re the captain.” This approach helped relax me that morning and gave me a sense of control, like handing over the baton to the surgeon with a smile and saying, “Ok, bring us home.” It was great advice, as it had a calming effect.

I woke up sometime later that afternoon. From the moment my eyes closed to groggily waking up, it felt like only a few seconds had passed. In reality, though, it was more like eight hours. The first thing I remember is Dr. Chetty telling me that the surgery had been a success and that he had replaced the valve with a mechanical one because it was too badly damaged to repair. I was now a little closer to bionic man.

I’d woken up in intensive care with more wires, tubes, and machines than I’d ever seen. The biggest tube was the one down my throat, breathing for me. The breath of life.

3. The Darkest Hour: Intensive Care

“No one is useless in this world who lightens the burden of another.”

— Charles Dickens

Doctors call the day of your heart surgery Day 0. The next day is Day 1. I knew intensive care was going to be the most challenging part, especially the first 24-72 hours. I had a dedicated cardiac nurse assigned to me on 12-hour shifts and during my time there, I had eight different nurses, mainly from India and the Philippines. They were like Guardian Angels: highly skilled and specialised in their field, kind and caring, providing life-saving support. My life was literally in their hands as they administered all my pain killers, medication, and ongoing monitoring of all vital signs.

That first night of Day 0 was hard. I kept drifting in and out of laboured sleep. I remember there was a white analog clock on the wall to my right. Each time I woke, I kept staring at it, mentally willing the hands to march forward towards morning. I often got the little hand and big hand mixed up. I’d wake up and think it was 3:05am when in fact it was only 12:15am. Time seemed to crawl to a stop. I’d sleep for what felt like hours, yet only minutes had passed. That was a long night.

The next day was an important (and difficult) one. Dr. Chetty liked all his patients to sit up and get out of bed into a chair a few feet away. I was told a couple of days before by the physio that this would be hard, but I should try anyway. I was ready. With the help of my physio and nurse, and clutching a folded-up towel to my chest to help soften the pain from my broken breastbone and incision, I sat up, gently swung my legs over the side and slowly stood up. Immediately, I felt extremely dizzy. I stood a few seconds, then collapsed into the chair before throwing up. I guess it could have been worse. The physio gave me time to recover before asking if I could take a few steps. I knew I had to do this, so I gingerly stood up with their support again, felt less dizzy than before, and took a few brief steps to just outside my room before declaring I was done and needed to return to the chair. It wasn’t quite a moon landing moment, but it felt like my equivalent of “one small step for man, one giant leap for mankind (or at least my recovery).”

I walked a little further with each passing day. My nurse and physio carried the blood drains and catheter that were attached to the tubes inside my body. I’d never felt so tired and out of breath after only a few steps. It felt like running a hard 5K or 10K. My heart and lungs were learning how to work again.

4. The Recovery

“Fall seven times, stand up eight.”

— Japanese Proverb

I returned home on December 26. I’d prepared myself for hospital but underestimated the recovery once home. I suffered a common post-op complication—excess fluid in my body. I’d gained around 8 kilograms, largely water and electrolytes, swelling my abdominal area but also collecting around my heart and lungs. This made breathing, walking, and sleeping even more challenging. Every step was difficult, my breath was strained, and sleeping was almost impossible as I had to prop myself up at almost ninety degrees in bed, like sleeping on a flight. The doctor prescribed medication (Lasix), then doubled the dosage, and fortunately, it worked. But it took time, about two weeks. I’ve now lost about 80% of that excess fluid and I can walk, breathe, and sleep more comfortably. Not yet as normal, but much better. It’s all about gradual improvements.

Living alone also brought its challenges, but I put some strategies in place. I hired home nursing support for two weeks during the daytime, and they monitored my health and provided peace of mind. I also had friends visit and help with things. I lined up plenty of books, podcasts, and some of my favourite TV shows, including The Wire (perhaps the greatest television show of all time) and the first season of True Detective. I struggled with reading at first. In 2023, I read 32 books, but in those first couple of weeks after surgery, I found it hard to open a book. My friend Puya had bought me an inspiring book called The Prophet, by Lebanese writer Kahlil Gibran, as a gift. When I told him I was struggling to read, he came over and read the first couple of chapters to me. It’s a beautiful book, and it got me back reading again. I’ve since read Kafka’s Metamorphosis and I’m now reading three other books, including The Power of Now by Eckhart Tolle.

I also built a daily routine, which included walking every day, deep breathing exercises, and gentle stretches/exercises that my physio showed me. Of course, there has been plenty of rest, too, and the most important thing I’ve done is listen to my body. I haven’t tried to rush anything or push myself.

I’ve found that a positive mindset, a strong mantra, and a visualisation of a healthier future have all played a vital part in my recovery to date. Some days have been better than others, and I had a few low mental moments (especially at night), but I always tried to refocus on the bigger picture and my mantra. I’m still getting used to the strange phenomena of the audible ‘clicking’ of my valve, but sometimes it’s quite soothing, like a metronome. As my surgeon said, “if you can hear it, it’s working.”

5. What I’ve Learned

“He who has health has hope; and he who has hope has everything.”

— Arabian Proverb

I don’t think I have a fully formed answer on this yet. I know some people believe everything happens for a reason. They might call it fate or destiny. I have a different view. I believe things happen randomly. Good and bad. That’s simply life. What I do think is important is how one reacts to these random acts. It’s in these moments that we can discover more about ourselves.

One thing I’ve learned is that by sharing my experiences, I can help others. There is a group page on Facebook called ‘Heart Valve Surgery Support Group’ with 17,000 members from across the world. Yesterday, I shared my heart surgery experience with the group, including some things that worked for me like my mantra and smiling just before going under. I received many supportive replies, including from people soon to have a similar operation or in the early stages of recovery who took something positive and inspiring—even hope—from my experience. And I’m sure these people will then share their experiences and in turn, help others.

My recovery continues. Everybody recovers differently and there’s no set rule. It can take two or three months, or sometimes longer. The breastbone can take up to six months to heal fully. I’m in no rush. I’m grateful to be back on the journey. I believe we are stronger and more resilient than we think. With the support of those closest to us, and a trust and belief in ourselves, we can each continue to write our own chapters of life. Thank for you reading mine today.

If you’ve been on a similar journey or would like to share your own reflections, as always, I’d love to hear from you in your own time.

Wishing everyone a healthy and happy weekend.

James

The photo below was taken yesterday, on Day 30 post-surgery.

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Thanks for reading and being part of the Deep Life Journey community.

James