Friday, 4 November 2016

Life with CABG Practical Theology from kiwiconnexion

Life with CABG David Bell and Julie Thomson

The full script as follows:
David: Welcome along to Live on Air tonight. I’d like to introduce Julie Thompson. Julie and I are going to talk about life with CABG, which I suppose is an odd title. Julie, you might like to explain what that work CABG is in the title.
Julie: Yes, that’s a very good idea; Coronary Artery Bypass Grafting. Now, this occurs when the heart muscle is deficient in oxygen, and is a lot more serious than when perhaps stenting or angioplasty is done, and so would be the final opportunity to retrieve that heart muscle and get it pumping sufficiently around the body.
David: Yeah, it’s an interesting and quite a serious sort of operation. I’m just going to move over so that Julie and I take sort of centre stage at this point for the discussion. The first question that we want to talk about, Julie is the emotional impact of unexpected surgery - not just cardio surgery, whether it’s open-heart surgery for valve replacement or grafting or stenting, but you’re a practice nurse so you would have particular insights into what happens emotionally when people are suddenly confronted with an issue where they’ve got to have invasive surgery.
Julie: That’s right, and often we’re making telephone calls, we’re seeing people face-to-face with this dramatic information, and it’s extremely threatening and fearful for a lot of people, because they’re not expecting it. Out of the blue, suddenly somebody has to be admitted from a medical practice into hospital. So, I think it’s fear, uncertainty, will they survive, what’s the outcome and the future?
David: Let’s move it away from the coronary stuff just for a moment. If it’s, for example cancer - could be breast cancer for women, could be prostate cancer for a man, or a whole variety of cancers; that emotional impact when you’re first given the diagnosis is really quite critical. So, do you have to deal with that often? Do you get people coming out after they’ve spoken to the doctor, and sort of been shattered in the surgery?
Julie: Yes, definitely and need to be put aside into another room for awhile, just to absorb that information. Often we might need to ring family, have some support in the surgery.
David: Right. It happened to me for the CABG stuff a little bit differently; I’m a great walker, and I’ve been walking, but my wife said she thought I probably did need to go and see a cardiologist. She reckoned I was starting to get puffed. For me, it was a little bit different, because I thought I had a bit of tummy ache, and we were walking up a local hill called Deep Creek Road one night after dinner, down at some friends, and I went about 20 metres up Deep Creek Road and I said, oh I’ve got to stop. Now, I didn’t have any pain here or here, or any of the usual sorts of heart-associated pains, but I did feel - it was a cold night, there was a cold wind - I just felt a bit unwell around the tummy area. I subsequently made an appointment at the local GP. The GP told me to not drink so much wine, which I thought was - and they were very strict about that. So, I must say, I haven’t had a single glass of wine since then.
The GP sent me onto a cardiologist and I went to the cardiologist, and they put me on the treadmill. I only lasted a little less than two minutes, and the impact was this; the cardiologist came in to see me - they nurse had been doing the treadmill test - and said, you’re going into hospital now - we’re taking you. So, it was a very unexpected kind of thing and my initial thought was, well obviously I’ve got to do this, and if they’re going to do it now I’m just as happy to be in the public system as in the private system. The cardiologist said, well you could go into my private practice, but you wouldn’t be seen until the following Thursday. In reality, it was a much better place to be in the hospital being monitored in a cardio ward.
Julie: I think it’s particularly so with chest pain. Anything to do with the heart or perhaps maybe to do with the hear makes people act.
David: Now, one of the people watching tonight on Live On Air is Dorothy Willis. Dorothy has had some of the most terrible kinds of medical misadventures that you could possibly have. I can’t remember the name of the condition that she has, but she’s watching an amputee and faces other possible amputations. So everything I’m going to say about life [as a 6:04] CABG, Dorothy has faced, from the perspective of losing limbs. There is another title; unexpected emotional impact. Julie, I’d like to ask the question of you; as a nurse, does it make a difference to you that you have patients or clients or whatever you call them, who have to deal with these things? Is there an emotional impact on you? Is there an emotional impact on the doctor - the local GP? What’s the answer to that?
Julie: I think there is, and I think I’m seeing it more and more that the medical profession in general is full of compassion, and does absorb a particular amount of paint through the patient. We still seem to like to call people patients - or the clients, because you know these people, particularly in General Practice; you might have nursed these people or looked after them for 20, 30, 40 years even, and you are definitely feeling that impact and pain.
David: Now, I think we have to understand that whenever you’re confronted with medical misadventure or serious diagnosis, when the diagnosis is very serious from the point of view of the patient, the questions of, am I going to survive, start to take over. I must admit that for me it was a bit of an interesting rollercoaster, because when I was initially the hospital, I began to get very elevated levels that were indicating quite big infection. It turned out that I had developed appendicitis, and that was the thing that had been going on for a number of years. I must have had a rumbling appendix that would occasionally do a bit of a flare-up. Well, it decided it was going to do its flare-up while I was in hospital. So, the critical question became one day; were they going to have to deal with a potentially burst appendix? So, I was told on the Wednesday I think it was, that a theatre had been booked to do the emergency appendectomy.
Well, sure; that’s laparoscopic surgery, but I had a very serious talk with the anaesthetist who said they’d talked it over as a team. They were confident that they could get me through the heart side of things, but there was a potential area of risk there. So I found myself, as we come to the emotional impact; what do you do when you’re faced with two procedures which are sort of mutually exclusive? So I had a fascinating night that night in hospital, and I was particularly glad that one of the parishioners had brought in my little laptop, and I was able to talk about this in a forum post; for me it relieved the stress. It relieved some of the anxiety to be able to say, well folks I may not be writing another post tomorrow night. It allowed me to get something out there and then. Any comment, Julie?
Julie: Yeah, David as you are a person who likes to be in control, I wondered how you were coping with the fact that other people took control of your situation and your life. Was that difficult for you, or just at that point in time did you accept it?
David: Absolutely. There’s nothing else you can do; you either accept and say, what will be will be - or if you try to fight that or go against it, then I think you’re in some degree of psychological difficulty.
Julie: How were you finding life generally, being in hospital for that long? A lot of people are in hospital for a few days, but you must have been in hospital for over two weeks.
David: Oh yes, well over two weeks. I can’t remember exactly, but I think I was eight, possibly nine days in North Shore while things were sorted out, and then you’re waiting to be able to get onto that conveyor belt of becoming part of the CABG population, or the valve replacement thing. We’ve got one viewer in tonight, David Erasmus who’s been through open-heart surgery and had valve replacement. We’ve got another viewer in tonight, [Stuart Mannins 11:27] who’s, like me, been in the CABG section. So, it’s a very well organised and incredibly efficient - as far as the public system goes at Auckland Hospital - very efficient, and beautifully caring, well-oiled machine; exceptional staff care, et cetera. Now, I’m not sure that I’ve answered your question, and it must be post-CABG syndrome; what was your question again, Julie?
Julie: How did you accept the fact that you had to stay there? You were dangerously ill. We all knew that. We were concerned, and you had to wait because you had these two issues of appendicitis and heart disease.
David: Yes. Well, I didn’t have any trouble accepting what was going to be. It’s as simple as that. Sure I like to be able to control certain aspects of things, but I’ve always found that life tends to sort of throw some pretty strange curveballs. So, not all the time do you expect to be in control, and particularly when it comes to health issues, I think you have to realise that, yup - life’s a gift, and it may not be for you tomorrow. One of our viewers, Max Thompson who just happens to be Julie Thompson’s spouse - is that right, or one of [13:09]. He says, what’s it when you find out that genetics are against you? Well, that’s a really good question, Max. From my perspective, my mother died at age 63 from bowel cancer, my father died at age 67, or 66 and a half - I can’t remember exactly. He dropped dead of a heart attack. My elder brother had stents and then CABG procedure just a few years after my father.
So, in one sense I’ve barely outlived out mother, and I almost didn’t outlive my father. So, you could say that the genetics were running against me, but I think it’s not genetics that’s the key here; it’s the epigenetics. I consider myself to be the most fortunate, lucky guy in the whole universe in some ways. Well, certainly if you wanted to use conventional Christian language, I would say blessed, because somehow or other, with all of the miracles of modern technology and science, I not only survived, but I feel as if I’m thriving at this point. David Erasmus asks; what are the bigger psychological effects on you after surgery? Now, I’m going to answer that in a minute, but Julie as a practice nurse, this is where you would see a lot of the effects, wouldn’t you? You’re dealing with the patients after they’re out of hospital.
Julie: Sort of following on from Max’s question as well, it’s the lifestyle factors, the medications, the advice that’s out there, the science, the research that we have to listen to; it’s a whole picture. If it’s elevated blood pressure, there are medications to control it. We know we have to exercise. We know diet plays a part. We know diabetes is not a good one in this as well. We know we shouldn’t smoke. So it’s a complete picture and I think stress [15:31] as well. We talked about stress tonight, and we’ve got to be aware that the whole lot play a part in disease.
David: Julie, when you’re dealing with people, let’s say after cancer treatments, which are much more ongoing than the kind of drastic interventions around the heart, what sort of psychological effects do you notice?
Julie: People vary a lot. People with positive attitude - as you said before, grateful for life - get on with life no matter what - those people will have better, more fulfilling life whatever that might be.
David: There’s no question that I think no matter what the intervention was, whether it’s chemotherapy, radiotherapy, radical surgery - whatever; there will be days when you get blue. There will be down days. Life isn’t just lived at a high, and I rather suspect that if you asked Dorothy Willis, our amputee, about this, she will, as a long-term amputee and as having faced this terrible medical condition over years, she’s had to learn not only, how do you cope with pain and how do you cope with the full effects of the worse kinds of a ravaging disease, but how do you cope with your own emotions? That’s why I think David Erasmus’ question is key. Now, the District Health Boards - Waitemata, Auckland et cetera; they all run programs at least for cardio patients, and I’m assuming they do this for cancer patients as well.
Julie: There are many organisations.
David: Yeah. So I’ve been involved over the last four weeks - once a week we go down to the hospital, we listen to a set of experts talking that day, and one of the key elements of that session is, how do you cope with the psychological effects? It seemed to me, listening very carefully, because it’s a very different group of people - a much bigger group of people than you’d find in a hospital ward, are gathered to listen to that, and I would honestly evaluate the group as not coping very well with the psychological aspects of medicine - of their treatments. It’s easy for me to say that, because professionally I’ve been involved as a clergy, my working life. I’m used to thinking about life and death and how it relates, not just to the people that I minister with, but how that relates back to me in my own life, and so on. So, I am aware that there will be days on which, yeah I don’t feel 100 per cent chipper, and there will be days when I feel, this is fantastic to be alive.
Julie: That’s important that you understand that, and that people tell you that’s going to happen.
David: Yeah, just being told that will happen - but it also raises the bigger question of, what happens when the sentence is a little bit different, if you like. That could be, we can’t do anything more for you. So, you’re coming to the end of life, and then a whole other set of issues about mortality raise their heads, and have to be dealt with. That’s what’s meant by the advance care planning. So we had a session with the cardiac psychologist who I thought was brilliant and we had a session with the advance care planning nurse, which I also thought was brilliant. Between the two of them, they were really saying, well you need somehow or other to gather your thoughts as best you can about what you yourself want to happen, should certain events overtake you. For example, if I have a stroke, what do I want to happen?
Now, I might think, oh well a stroke’s the end of everything - I don’t want - mark me Not For Resuscitation. That needs to be much more carefully thought through. Some people of course, they will have relatives that say, you must preserve life at all costs, and this is directly contrary to what the patient themselves desires. So, there’s a range of things to be considered here, but the important lesson that I learned was that in advance care planning I can phone the DHB, ask to speak to the advance care planning nurse, and at least my wishes can be recorded on an advance care plan, provided I’ve thought them through logically, carefully et cetera.
Where I think this all is great in theory but falls down in practice, is we’ve seen the New Zealand Police commit absolute idiocies with a little local euthanasia group, and they’ve targeted little old ladies going off to hear about the end of life, as if somehow they’re all about commit suicide. This is just utter nonsense. In fact, because we’ve got before Parliament at present, the physician assisted dying - is that what it’s called? I’m not 100 per cent sure of the bill’s title, but believe me; what you say needs to be heard by the medical profession, and they make every endeavour to listen to what you’re saying. Julie, do you do any advance care planning with your patients?
Julie: Well, I don’t have that experience, but we do encourage people to be honest about what they would like to happen to them, but it does need an expert nurse. It needs knowledge. It needs people to get on and do this, even if they’re critically ill, do you think?
David: Yeah, I do. It’s a bit different if it’s going to be a sudden catastrophic event - that can be different from if it’s, for example, Huntington ’s disease which is vicious and fast. I just saw that there was a new drug for Cystic Fibrosis. There’s a new drug, and they said that in Britain, at least half the population that has Cystic Fibrosis can expect to live to be 40. When I first started in ministry, I think we were talking about most would die before they were...
Julie: Ten, I think.
David: Yeah, 10-15 then it slowly moved up to 20. So, care has been advancing. Drugs have been advancing. It’s possible to make uninformed decisions about the end of life, but equally if you’re convinced that this is what you want, then I think you need and owe it to your family to say, this is it - this is what I’m putting forward to the hospital in the event that I end up needing procedures, et cetera.
Julie: You could change your mind, I guess about what you wanted.
David: Yeah, it’s an interesting one. Carl Jung really said something that I think was incredibly; everyone, no matter whether they’re suffering from disease or whether they’re happy - not matter what their stage of life - everyone lives as if they will live forever. You can’t actually live any other way, but you must plan - he didn’t say this, but you must plan for the fact that of course you won’t. While you’re alive you have that duty of care to yourself that the gift of life is within you. If there was a point at which you would want to say Praise the Lord, it’s the fact that there is life going on, and it has a purpose, and it has a meaning.
It’s when you don’t see yourself as having a purpose and meaning that I think things start to really fall apart in the psychological sense, but I do believe in Jung’s maxim of you’ve got to live as if you’re going to live forever, but you realise fully that won’t be the case. Julie, I think we’ve come to the end of Live On Air, as life as a CABG - well, we’ll do 20 minutes. So we’ve done a lot better than that, and I hope it’s been interesting for people. We’ll say goodnight, and thank you very much, Julie for coming in and joining me.

Julie: Thank you, David. We’re still you’re back.