Australia / Think Piece

Fixing A Hole

This is a sequel to my post about the stroke here.

I sat on the third plane. I had a window seat. My bladder got anxious. A middle-aged couple sat next to me and in a matter of minutes I recognised their flat vowels and light-hearted attitude and said without urgency to commit, a friendly “hello”. And then, unlike me, or rather, a past version of me, said, “I’m sorry in advance for asking to get by for the toilet so often.” What was going on? I was extending the conversation. The couple from Melbourne said it was no worry, and that they needed a reason to move around a lot anyway.

“We’ve got the compression stockings on,” said the woman. “Don’t want to risk it at our age.”

“She’s a nurse,” said the man. “Knows best, you see.”

“Oh?” I said, and deliberated. Do I tell these strangers an intimate detail about myself? She’s a nurse, I thought. Probably good to get her on side. “Me too! I’ve got the thigh-high ones on,” I said, perhaps too excitedly.

“You’re too young to worry about that, aren’t you?” asked the man.

“Well, actually I had a stroke a few weeks ago,” I said. “Actually, a TIA. I’ve had two in my life! So I had to inject myself with a blood thinner-”

“Clexane?” interjected the woman.

“Yeah. I stuffed it up, though. Luckily mum’s a nurse, too. Halfway in, I let go of my skin and the needle came out and liquid went everywhere.” I chuckled, even though at the time I was mortified. “I called my mum and she said to just try again on the other side of my belly and only inject half the liquid in. I’ve already got a huge bruise.”

“You said you’ve had two?” asked the woman. “Do you know when the other one was?”

“Not really,” I said, “but there was one day at work a few years ago when I was really stressed and I suddenly couldn’t see very well. I couldn’t focus and wearing my glasses didn’t help. It was like a migraine.”

There’s a weird satisfaction I get when what I’m saying captivates an audience, even though I’d told this story many times and I felt a bit self-involved. Nonetheless, the three of us spent the next seven hours from Doha to London exchanging pleasantries as I shuffled past their seats for the loo and during meal times. It made the trip go much quicker, and I felt comforted to have a medical professional in my row.

***

“So, Sam,” said the stroke specialist, shifting in her large leather office chair. “Why do you think the stroke happened?”

“Uh…”

“These Transient Ischaemic Attacks are random events. I believe it’s just as useful for me to know what was going on for you when it happened.”

“Oh.” I blushed. My heart picked up some speed as it does when I’m about to be vulnerable. But, doctor, we’ve just met! I thought. “Well, I worry way too much about affairs of the heart,” I said.
“I probably worry too much about a lot of things, especially about whether I’m good enough. I fear abandonment. I’ve had panic attacks before. Just before the stroke happened my brain felt like it couldn’t handle anymore of my circular, negative thoughts. I felt good that morning, though.”

The specialist wrote down some notes.

“Very normal thoughts. If it’s any consolation, I dated many duds until I met my husband when I was 38.”

38! I thought. Thanks for lowering the stakes. There’s still time.

***

“What’s a man your age doing in my office?” said the heart specialist.

I apologised, and said ha ha ha, then fell silent.

“Now, there are three types of hole – or PFO – you can have,” said the specialist. He put a scrap piece of paper between us and started drawing a Pictionary-esque sketch of the chambers of the heart. “The hole is here between the left and right atrium in the atrial septum. About a fifth of the population has one. It doesn’t close up after birth like in the majority of us. Now,” he started on another sketch, “the type of hole you have is definitely worth closing up.”

All I can remember is that the type of hole I have involves tissue that flaps about. Or maybe that was the only image I couldn’t get out of my head.

“We will make an incision in your right thigh around your groin, and send up a catheter. Inside is a wire. We thread the catheter through the hole, and we unsheathe the wire, which then opens like an umbrella. We pull back the catheter further, and another umbrella springs open on the other side of the hole, closing it up like a hamburger. Within three months the septum tissue will grow over the device.”

“Crazy what you can do these days,” I said.

“Not so long ago the only way to close a PFO was open heart surgery. Lucky we don’t have to go through all that anymore.” The heart specialist was an older man, his way of relating with me was to mention cricket and standing to attention on parade as an army cadet. “Oh, we also have to send a scope down your oesophagus again so we can see what we’re doing.”

I fought the urge to blurt out “spit roast surgery”.

“Do you have any questions?” he asked.

“I’ve read,” I said, “that having the hole closed might make me physically more able. I’ve never been able to gain a certain amount of strength, or build up cardio no matter how much I train. Will the procedure help?”

“Don’t count on it,” he said, simply. “Maybe that’s just the way you are.”

I was a bit crestfallen. “What about circulation? Sometimes my joints and extremities feel odd, kinda numb, kinda empty.”

“Well, I don’t know anything about that.” He said it in a way that reminded me of Dumbledore’s benevolent smoke-screening of facts for Harry.

***

 “There’s no consensus on whether closing the hole will protect you from further strokes,” the stroke specialist said. “We still don’t know the actual cause of it. The device is not guaranteed to stop clots from forming.”

“Oh,” I said. “The heart specialist said that I definitely needed it closed.”

“Oh, in that case, yes, get it done. But you might hear people say that you shouldn’t.”

I looked at her, quizzically.

“But if I were you,” she went on, “I’d get it done. It’s something that can be fixed. Can’t hurt. We’ll keep you on blood thinners, though. Will probably upgrade you to rat sack.”

“Pardon me?”

“Warfarin. Used to be used to kill rats.”

“Oh.”

***

 So on Friday this week I’m having patent foramen ovale closure surgery. I’m kinda looking forward to it, even though I’ve been told not to expect any change in anything afterwards. Plus I get to relish telling people I’m having heart surgery. I love the attention.

Here’s a pic of what they do:

Medical illustration depicting minimally invasive closure of Patent foramen ovale (PFO). 1. Blood flow between the chambers of the heart. Yellow arrow depicts blood flow through the Foramen ovale. 2. Catheterization 3. Septal occluder closing the foramen. 4. Circular discs covering the hole on both sides.

Medical illustration depicting minimally invasive closure of Patent foramen ovale (PFO). 1. Blood flow between the chambers of the heart. Yellow arrow depicts blood flow through the Foramen ovale. 2. Catheterization 3. Septal occluder closing the foramen. 4. Circular discs covering the hole on both sides.

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One thought on “Fixing A Hole

  1. Pingback: Like a Hole in the Heart | An Odd Geography

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