My trips (am far from declaring it a vacation!) to the edges of existence continues. I underwent a bypass (coronary artery bypass graft) on Aug 29th.
During my last admission, there were lots of views on risks versus benefits of doing the operation. My zen master nephrologist Dr Rammohan Bhat took charge and wrote the following. I am reproducing it verbatim. This was the preamble to the decision to go with the bypass and the current admission.
Following discussions with Dr Sanjay Mehrotra and Naresh + Wife, my views and suggestions are as follows;
- Naresh and wife have realistic expectations from the proposed CABG and understanding mortality and un recoverable renal failure risk. They are willing to take it on as long as we all work as a team to support them.
- Naresh understands that dialysis post op is almost inevitable but there is a possibility of kidney function improving such that he can come off dialysis as long cardiac EF improves. Naresh is prepared for a life on dialysis if Kidneys don’t improve.
- Given that Naresh has had GI upset and looks very dry, I want to stick to 20Mg Lasix everyday for now and no aldactone. I would not recommend that we operate on him for the next week or so. We could discharge him – monitor closely and readmit next week – plan surgery 2nd half next week.
- Kindly involve me in any decisions regarding changes to his medicines. I would specifically want any changes in fluid allowance and dierutics to be communicated to me.
Pressing forward, bringing people together while not subjecting anyone to unreasonable expectations are powerful synonyms for leadership. I can’t think of better words to capture the situation and put forth a powerful case forward for action.
The pre op was complicated the balance between increased diuretics and creatine levels was hard to achieve. Psychologically, I have never been in a better state. Accepting all possible outcomes, knowing deeply that this is going to unfold the way it is meant to; provided me incredible strength. The way to recognize and deal with the onslaught of nature, for me, was to acknowledge, accept and maybe be curious about it.
Most of the times, what was happening did matter. But, interspersed were steady glimpses of the infinite coming from a place of don’t know, don’t want to know, who cares , can’t know, no need to know, not possible to know and nothing to know ( thanks Byron Katie for some of these beautiful words). There was no individual doer. It is crystal clear that imagination has constructed me, my world. Once I understood, reality was never far. I stop believing in my thoughts and the edges of existence merge with death. Thoughts became shadows. There was no fear of death. The source for all is the same. The complete acceptance of death is deathlessness.
My dream team (Dr Sanjay, Dr Sharat, Dr Seshadiri and Dr Bhat) worked together . They went in knowing this was complex and it was. My meds had caused its own effects on the heart which had to be cleared. My veins were not in great shape for the graft. But I woke up a day later and came off the ventillator- a milestone for me. 4 days in the ICU with the amazing nurses and I slowly came of the catheter , iv drugs, peripheral IV line etc.. A friend of mine was joking with me about making sure that I do not give any sermon in the ICU , and avoid getting my attender to a meditative state and causing her to forget performing her role as an attender. Luckily none of the happened.
I have been told that I should not obsess and worry about the heart now. And live life. The kidney is holding without any need for dialysis. The impact on my general weakness , fluid retention etc.. will unravel in the next few months. I am currently prone to exhaustion, lots of pain in the suture, shoulder and legs. The sternum seems to be the least of the problem. Coughing to bringing up the sputum is important and painful. I am trying to be on a strict exercise regime. Walking, simple stretches, improving lung function by blowing etc… occupies my time. Rest of the time, I tend to rest or keep still.
My prayer before my operation was ….
Please do whatever you think I need. If you decide I have to do some work for you in the world; then please make sure I always remember you in every second, every act every person. If you decide my time is up; then please keep an eye out for Nisha, Ashwin , Amita, Dad. I know you always do, but …..
Yours
One of my favourite places in the world “Anandashram” had a special prayer for me. I was a man daring to see what life has in store for me after this.
Amita and I had a lovely acknowledgement the day before surgery. That we have together grown immensely in the harshest of climates. It is abundantly clear to everyone that her balance, attention to details, energy, willingness to forego her career and priorities has been the pivot to my continued existence. I have always questioned what is worldly love; but this sounds like a pretty good definition.
Amita’s mom and dad took over the house sending critical delicious home cooking. Ashok flew in from San Jose . I felt it was important for Amita to be with someone during my ICU days. He was magnificent quiet and strong.
We had many many well wishers send their constant prayers and encouragement. Those were critical for us as we struggled to remain in touch with the known.
As we stumble ahead, I am in awe of India’s health care system for the rich. I cannot imagine it being better anywhere. Maybe better equipment, but nothing like a nurse from Kerala and the docs here. The skill level is amazing because of the volume of work being done here . All done at a tenth of the cost. Of course , India’s health care system for the poor is worse that the worst in the world.
I am also in awe of the transformation power of love, prayers and well wishes.
Thank You.
Noodles with Naresh 