I was on my own, on the top floor of our house in London. It was just another day, getting ready to go to work and about to drive down one of the busiest stretches of motorway in Europe. I was sitting on the bed putting my shirt on, stood up and out of nowhere felt a sensation like no other, beyond pain and words really - a kind of internal rip, like the top half of my body was detaching itself. (The surgeon later told me that this is what it would feel like, if I were shot in the chest).
Terror flooded me. I knew instantly that it was something catastrophic and I remember calling out "I do not want to die!" as I staggered towards the bedroom door. I remember those few steps and seconds, but curiously from behind and to the left of me, like a camera recording it. Then nothing.
About twenty minutes later (I have since calculated), for some reason, I regained consciousness, finding myself lying on the bathroom floor. I remember there was total nothingness. I had no idea what I was, or who I was, where I was or what being 'where', was.
Gradually though my "identity" - me, returned. I instinctively knew that something must be badly wrong (funny how like animals in these moments we know) and knew I needed help. I tried but could not, at first, remember what the number was for emergency services. That it was "999" gradually came back to me. Because of its size and high density of traffic, London has paramedics that patrol the city on motorbikes, so they can get ahead of an ambulance. The question I was asked was "can you get the front door open?" A simple, obvious, but crucial question.
I have read many articles about misdiagnosis of aortic dissections, (patients being sent home having been told they have anxiety etc.) and how the critical tool for diagnosis is a CAT scan. Luckily for me at Charing Cross Hospital in London, they did that straight away and diagnosed the problem, but its comparative rarity or the lack of exposure of ER Doctors to it, was shown by me hearing the cardiologist explaining to the main medic on duty "Can you see it ... it's there".
Not much was explained, but I was told I would need surgery and was going to be transferred to another hospital. I felt reasonably stable though I was sedated by this time. But I remember the feeling of a heavy weight on my chest and one moment when a sudden pain went through my back that was so strong, that I'm pretty sure I levitated off the gurney. I could see it alarmed the Doctors. By now my stepson had arrived at the hospital and they had prepped me for transfer (catheter etc.). A group had formed at the end of the bed waiting - two Doctors, two ambulance men. Suddenly the female Doctor went ballistic - "what the f ^^ k are we waiting for - we need to f ^^ king go now". Hearing this and looking back now, it all felt surreal. A short time before, my everyday life was proceeding per its routine and now it seemed like control of my life was slipping out of my hands. That things were obviously very serious, was confirmed when even more medical staff climbed into the ambulance, including the cardiologist. I would later learn that my aorta had leaked five out of the eight pints of blood into my body, which obviously causes a major drop in blood pressure and the medics were concerned that my heart would arrest. I felt weary in the ambulance. I was afraid but accepting at the same time, if that makes any sense. A phone was passed to me and I spoke with my then wife who was in Spain. She told me to hang in there for everyone. On arrival at Hammersmith hospital, I remember the cardiologist who had come in the ambulance saying "all the best". Those three words spoke legions. Being wheeled to theatre on a trolley and looking up at the ceiling lights, yes, just like it was some medical drama I was watching on TV, a surgeon waved a piece of paper at me. "You need to sign this, John" I hesitated. "You do not have a choice" I don´t think I got much more than a wiggle of a line on the paper. Then there were those few seconds as the anesthetist did his thing and.....
The following day at around midday, I regained consciousness.
I had suffered a Type A Aortic dissection, which had been repaired with a Bentall root replacement (prosthesis). My aortic valve had been damaged and this was replaced with titanium. As everyone who has suffered this knows, this surgery is immensely complicated - working with the connective tissue of the aorta being described as like working with blotting paper. I'm in awe of these surgeons who are artists with their skills in such repair. Because fitting a new valve is such a delicate and precise operation, a pumping heart makes it very difficult, so it is stopped while this is stitched in and the patient is kept alive on a bypass machine. I reflect back sometimes on that time of which I know nothing and during which Mr. Punjabi and his team saved my life. Thank you Sir for your selfless work during the surgery and after, when you were so compassionate to me.
The next few days in intensive care were a blur. As is customary, it seems, two nurses on rotating shifts, sat on a raised platform with an array of machines and data and kind of 'flew me'. Oxygen was blasted into my lungs for hours to get my oxygen levels higher. Pain came intensely with a post-operative pleural effusion, but also in tasks that I had previously taken for granted, like, er, breathing. I also had atrial fibrillation. But gradually, I grew stronger.
A couple of weeks later it seems the lower half of my aorta dissected from the prosthesis down to the bifurcation in the legs. This I'm told is too extensive to operate on - there are too many risks of blood loss, paralysis, and organ damage. So endovascular intervention is not an option. Now that I have actually studied my aorta, I can see why, I appreciate what a supply highway is to all parts of the body - kidneys, liver etc. This condition is managed defensively by blood pressure medication / beta-blockers and blood thinners, the former with the aim of reducing any spikes in pressure, which might stress the aorta and risk widening the dissection and the latter to prevent the risk of a blood clot that could get stuck on the artificial valve and stop the heart.
This whole event has been changing life in so many ways. There are positives as well as negatives. Having been so close to death, I am more sanguine about its inevitability and aware of my own mortality. I think I am more resilient to life's knocks; they have been plenty as the injury has caused a tsunami for my family on many levels. I've been told there are no guarantees that the aorta, like a worn piece of rope, will hold, so I live with the fear everyday. We all know that we are going to die; it's just that we tend to ignore it - it's something that happens to other people. But with this condition it stalks and I know that my survival chances are not better than fifty percent. But plenty of people who have had cancer face the same odds of it returning and that is life. In the first couple of years after it occurred, I would have the fear when getting up from the bed or a chair, if it would happen again and I realised that I was in a kind of paralysis of PTSD. But you cannot live your life forever sitting still, in case something might happen to you. Of course one of the issues, is that from the outside I look fine, maybe even healthier than before, so unless I tell people, they do not know anything is wrong with me, or those that do, forget that for example walking up any kind of an incline can be a struggle because of the beta-blockers.
But as I wrote at the beginning, every day is just another day.