Regular readers: I’m sorry this one has taken so long to appear. The website was broken and I was having trouble fixing it. I’m not sure why it is working now, but, on with the story…
To the Operating Room
It was maybe 8pm by the time we got word that Andrew Hodge was on his way. The team of doctors and nurses that were now constantly surrounding Trenna started moving her bed to the lifts to take her to the OR. I tagged along.
We went to whatever floor it was and everyone halted in a sort of anteroom near some operating theatres.
I kissed Trenna goodbye and wished her luck seriously thinking that I might never see her alive again
‘We need to get a line into her first,’ said one of the doctors.
Equipment appeared and a young doctor started trying to find a blood vessel in Trenna’s arm that hadn’t collapsed and that still had some blood in it.
‘Shit,’ he said as he stabbed Trenna and failed to draw any blood.
‘Shit!’ as the same thing happened again.
At about this point a nurse grabbed me by the arm and said,
‘you’ll have to leave now.’
I kissed Trenna goodbye and wished her luck seriously thinking that I might never see her alive again.
I was shown to a room were I was told I could wait and that the surgeon would come and see me when they were finished. What an anxiety laden four or five hours that was! I had no idea what would happen next.
Eventually, some time well after midnight Mr Hodge appeared in the doorway. I don’t think he was smiling, but I could see he wasn’t sad.
I’m SO glad to see you. I wasn’t sure you were going to make it!
He reported that yes, Trenna had been bleeding and it took a lot of work to repair all the leaks. It is now a long time ago but I’m pretty sure he said that they needed 7 units of blood. He told me that Tren was going back to ICU and that in a while I could go and visit her there. Then he said goodnight and left the room.
ICU Again
At least I knew what to expect this time. Everything was similar to last time except Trenna now had a third large drain emanating from her abdomen, and she was much less responsive.
I think some time in the early hours of the morning I eventually made it home and collapsed into bed, pretty confident that she was now in good hands. And that proved to be the case. Tren seemed to be getting better at ICU and I think she was only there for a couple of days and then back to the ward where everyone seemed to be happy and relieved that she was back.
At one point the Registrar who had rung Hodge a few nights earlier came into Trenna’s room and said ‘Oh! I’m SO glad to see you. I wasn’t sure you were going to make it!’
There is another anecdote worth relating. Trenna told me that she was in that anteroom waiting to go into theatre and the battle to find a viable vein was taking a long time. She was still conscious and remembered it clearly. She said there was someone, she presumed Mr Hodge, calling out from the Theatre saying, ‘If you don’t get that line in I’m coming out there with a scalpel and opening up her arm to find one!’
Trenna then set her mind to recovery. At least a few times a day I was kicked out of the room whilst the physiotherapists tortured Tren. As she described it they would sit her on the side of the bed and get her to hold a pillow to her sore chest and then they would pummel her back. I believe it was to ensure her lungs fully recovered, but it clearly wasn’t a very pleasant experience.
Stuck in the Cardio Ward
Trenna had been in hospital a couple of weeks, she was feeling (relatively) alright but they weren’t letting her go home. They wanted to make sure she wasn’t going to leak again but they also needed to sort out issues to do with her coagulation levels.
There were a couple of things here. If people have a metal heart valve, like Trenna’s they need to take anti-coagulants to stop clotting that would otherwise occur around the heart.
To that end they had started giving Trenna the anticoagulant warfarin but only in small doses. Presumably they didn’t want her to start leaking again. The idea is that the effect of warfarin slowly builds up over a period of time. However, the risk of clotting is a more immediate danger, so a few times a day Trenna was given an additional anticoagulant, a heparin injection into her stomach.
Hmm. Do you think your husband could do it?
This was a terrible experience because every nurse who came to administer it would start by apologising because they know how much it hurts. According to Trenna ‘it stung like crazy – it hurt so much.’ It is worth remembering that some years later a non-stinging version of heparin was developed which apparently resolved this problem.
But in 1990 they only had the stinging one.
Home
As part of the process of getting the anticoagulation right Tren would have daily blood tests to get her PT Time. The warfarin dose for that evening would then be adjusted up or down according to this test result. The PT was the prothrombin time. In later years people stopped mentioning PTs and started using the term INR. Basically the PT Time determines the INR.
Regardless of what it is now called Trenna’s was up and down, all over the place. As she was getting physically and mentally stronger she was starting to get increasingly grumpy about being locked up in hospital.
I was with her one day when the doctor came around on his rounds
‘I want to go home,’ Trenna said.
‘Yes, I’m sure you do,’ he replied.
This wasn’t news to the doctor, she had been onto him for a few days.
‘Well, when can I go home?’
‘We’re still waiting for your PT to stabilise.’
‘Well what’s the difference between me being here and waiting for it to stabilise and me being at home and waiting for it to stabilise.’
‘You still need the heparin shots three times a day.’
Then he had a thought. ‘Do you have any friends who are nurses?’
‘No?’
‘Hmm. Do you think your husband could do it?’ I was sitting right there next to the bed but no one was consulting me.
‘I’m sure he could,’ Trenna said, only slightly glancing in my direction.
Nurse Greg
So I found myself at the nursing station half an hour later with an orange and a syringe practicing the technique for subcutaneous injections. Fortunately it wasn’t a particularly difficult technique to master and the head nurse gave me the tick of approval, albeit saying to her colleauges ‘I’ve never know them to do this before!’
In another half hour I was packing Trenna’s things awaiting the final discharge to come through. And for the delivery of a big paper bag of syringes, needles and glass ampules of heparin.
We were both very relieved.
Convalencence
Everyone was happy when Trenna finally arrived home from her two or three weeks in hospital. I was pleased for Trenna and myself, but also for Prickles.
When Trenna was in hospital I would come home each night to find Prickles waiting patiently to greet me by the front door. She would also listen attentively each day as I gave her a summary of how things had gone at the hospital that day, and how Tren was going. I felt a fair bit of comfort in giving the dog my daily reports, and I know Trenna thought it was good I was sharing the experience with someone!
We really hadn’t given any thought about how we would care for Trenna during her recuperation. I didn’t feel bad about that as we had no real choice about having the operation. But it could have been a real problem.
As it turned out it wasn’t. Almost every weekday my Mum and Dad drove the 20 minutes to our place and sat with Trenna the whole day. Making cups of tea, preparing her lunch and keeping her company. They supervised her as she started walks around the back yard. We hadn’t asked them to do it, they just stepped into the role.
For the first week or more I came home from work at lunch time and gave the heparin injection – Trenna trying to underplay how much it stung so as to protect me. I gave them morning and night as well.
what a nerve that guy’s got.
Mum and Dad and Trenna spoke with each other a lot. I’ve mentioned before that Trenna wasn’t an instant hit with my parents, but as this convalescence period extended over weeks and weeks Trenna well and truly won them over.
Medical Review
We had a follow-up appointment with Mr Hodge after several weeks and he was happy how everything was healing. I don’t think we pressed him on the need for the second lot of surgery.
Then a month or so later we had a follow up appointment with Dr Mews, the Cardiologist.
He reported everything seemed to be going well and that we should make an appointment every 6 months to see him, ‘just to make sure everything is going OK.’
‘Oh,’ said Tren. ‘Andrew Hodge said we should see him in six months time, then see you six months after that and so on.’
‘Oh, did he? No, you don’t need to see him any more. Just come and see me every six months,’ said Geoff Mews. He then sort of huffed as if to say ‘what a nerve that guy’s got.’
Aftermath And The Rest Of Her Life
In the end Trenna’s heart operation was a big success, and we attribute it to giving her her at least an extra 30 years of life. However, there were further ramifications of the operation.
For quite awhile, I think Trenna had subtle effects from the trauma of the whole experience, the two lots of general anaesthetic administered over many hours, the trauma of having to go back into the operating theatre, the horror of a surgeon saying he was about to come and open up her arm before any anaesthetic had been administered. It all added to what was really quite a traumatic medical experience.
The changes were very subtle and I don’t think they had any real long-term affect.
Ticking
Another thing that had a bigger affect than we had expected, was the loud ticking noise that her heart made. It wasn’t such a problem after the first few weeks of getting used to it. However in public it sometimes did cause some anxiety.
When everyone was quietly standing in a lift the ticking noise was very clear. One time when Trenna was admitted to hospital for another reason she was in a two-bed room. A visitor on the absolute other side of the room could clearly hear Trenna’s ticking.
When Trenna went to university she was concerned that other students doing tests would be put off by the ticking noise that she made. It really was quite loud, but I doubt other students would have been distracted for more than a moment.
eventually she actually wore the scar as if it was a badge of honour
Alcohol
That big operation changed heaps of other things in our life.
The fact that Trenna could no longer drink very much, just one, or occasionally two glasses of wine a night made a big difference to the way we acted when we went out to a restaurant or to a party. Look, I know you can have great fun without alcohol, but sometimes it really does assist frivolities.
Scar
The large, very evident, zipper-like scar went from Trenna’s neck down to the bottom of her rib cage. For the first several years, Trenna rarely wore tops that had low necklines. She was concerned that people may feel uncomfortable seeing the scar, or perhaps more correctly, she didn’t want to draw attention to herself and highlight that she was different to others. I believe these feelings were grounded in the bullying she suffered as a teenager.
Over the years this did change and eventually she actually wore the scar as if it was a badge of honour.
Trenna was very impressed when we both started watching Sons of Anarchy on TV and we both met on the screen Gemma Teller Morrow, the matriarch of the bikie gang. In the show Gemma has a cardiac scar not dissimilar to Trenna’s.
In the show Gemma is a strong character who Trenna certainly felt some affinity with. The fact that she had and showed a cardiac operation scar added to her appeal from Tren’s point of view.
Interestingly the actor who plays Gemma doesn’t actually have a scar.
Children
Being on warfarin permanently also affected Trenna’s ability to have children.
It is true that we didn’t have any firm plans to have kids before the operation. But I don’t believe it was an issue that was discussed at all with us when deciding what sort of valve to have.
The choice of valve type determines in part whether you are on warfarin permanently or not.
I almost certainly will do a separate story in the future on being childless, but the heart operation did have an effect in that decision.
INRs
And being on warfarin meant that Trenna had to have very regular checks of her INR to make sure her warfarin dose was correct. Things like other illnesses, other medications, diet and alcohol all effect the INR.
At times she would need to have blood tests every two or three days, but mostly it was every 3 or 4 weeks. For many years when we went to see the GP she could draw the sample, and between trips we would visit the pathology collection centre. There was even a period when the phlebotomist would come to our home. Trenna struck up some brief but pleasant relationships that way.
Eventually home INR testing machines were developed, and instead of a large vial of blood being needed these worked on a pinprick. We bought one of those machines. They gave an immediate readout of the result and Trenna and I became expert at figuring out how to vary the warfarin dosage.
The machine was a bit of a game changer but we always just had a sneaking suspicion that the test strips were quite a bit dearer to buy than they really needed to be.
The Philosophical Bit
There are some events in life that change everything. Trenna, having an operation to replace her ascending aorta, was just such a case. Until then we genuinely thought we probably only had a few years together. At most, less than a dozen.
The operation meant that we had 33 years together. Trenna lived more than half of her life with me. And that is a big change.
The extra years meant we were able to travel more, live in Darwin for a couple of years, see friends and relatives grow up and have babies. Relationships we had grew stronger, and in a few cases they disappeared.
As I hope you have seen from this website, we accumulated two lifetimes of memories.
On the other hand, it also meant a much longer period of ill-health, worry, and the mutual concern and anxiety we had for each other. And in all likelihood a greater wrench when it eventually all came to an end.
Don’t get me wrong, I’m so glad that we had those extra years.
I wouldn’t have traded them for anything.