I have taken care of many patients over the past dozen years. Each patient gives you a little nugget to tuck into your nursing ‘experience’ file and your knowledge base grows. You learn what to do, you learn what not to do. Truth be told, no matter how many years you have tucked in that experience file, it does little to prepare you for being a patient yourself.
Back in February 2017 I finally had my appointment to discuss cardiac ablation procedure. Normally, healthy 40-something year olds accompany their parents to discuss this procedure but today I was the patient. I had been dealing with paroxysmal (or intermittent) atrial fibrillation (A Fib) since about 2008. When you research A Fib – it doesn’t sound like something I should have. I am not above age 65, no history of heart disease, no heart defects, no high blood pressure and no family history.
Why jump to a cardiac ablation? After nine years of dealing with A Fib I knew something had to be done. So after my February 2017 appointment I was contacted by the doctor’s nurse navigator, Cristina, and scheduled my ablation for April. Then a few weeks later I cancelled said ablation. Husband was at work, happened to be my brother’s birthday, kids had hockey – I had a list a mile long. So then I rescheduled for June. Then I cancelled June; schedule issues conflicting with hockey camp. Cristina gave me a handful of dates in July and August – and finally picked the very last Monday in August. First slot of the day. Furthest date away. My husband noticed that he was scheduled to work that day and quickly squished any notion of cancelling it – he would find a way to get off. Drat.
Then in early July I considered canceling again. I had been doing well, my running had picked up – the more I ran the better controlled it seemed to be. Maybe I should focus on running a few months before I decide on the ablation. Shortly after these thoughts I went out for a run. It was a beautiful morning, not too hot for a Sunday in Chicago. My pace was amazing; hadn’t even stopped yet. My goal was 5k and I was less than a half mile from home. Then the thump happened. Pretty certain I shouted a few obscenities as I stopped running. A quick check of my pulse and knew what had happened. Couldn’t count a heart rate – it was going too fast; but I felt ok. I started walking and captured my heart rate on my Apple Watch.
There was no way my heart rate was 49. I kept walking home, only a few blocks away and my goal of a 30 minute 5k quickly disappeared. I could feel myself recovering from my run, but still could feel the irregular heart beat. Normally, if this would happen to anyone else, I would tell them to head to the emergency room. I happen to be a bit stubborn and decided to ride it out.
I let my husband know what was going on (he, of course, was at work). By the time I got home my watch was capturing a heart rate of 189. I was able to drink some water and even changed out of my workout attire. My oldest son had a driving lesson scheduled, so I had him drive to that while I rested in the passenger seat. During the drive home I could feel my heart rhythm convert back to normal. This episode lasted about 45 minutes.
After my little run, I knew there was no turning back & I had to keep the ablation scheduled. So I did what I thought best. Completely ignored the fact that I was having this done. Rarely talked about it, didn’t research it. I knew what was going to happen, but I really didn’t want to know exactly what was going to happen. I did take the time off of work (no turning back when Kronos approves a week off), but other then that I rarely gave it a second thought.
The weekend before the procedure I didn’t feel good. I wasn’t sick – but I knew what the plan was for Monday morning and the cloudy, rainy Chicago weekend leading up to it wasn’t helping my mood. My biggest regret was not preparing the boys better for my absence. I did not want them to worry. They knew I had a doctor “appointment” that morning, I think the older boys knew it involved a procedure, and that Grandpa would be taking them to school. After school and dinner time brought many questions and they were even more worried knowing I wouldn’t be home till the next day. Thankfully a quick FaceTime that evening helped bit as well as a promise that if I ever do anything again they would know prior.
Arrival at Northwestern Medicine in downtown Chicago was an easy drive at 5:30am on a Monday. Not being able to eat or drink anything on the ride was a downside, but at least I could enjoy the aroma of coffee as I continued to try not to think about what was happening. Checked in at the electrophysiology lab desk and quickly brought back to the pre-op area. Changed into the fabulous standard hospital gown attire, obtained some wristbands and hooked up to monitors. IV line placed, labs drawn, vitals taken. Then the parade of physicians and NPs began. We had anesthesiology, cardiology, ultrasound (for the TEE) and there might have been one other person. I just kept signing consent forms.
Once all that was done there was concern that I was running a temperature; 100.2 I believe was the highest they read. I felt fine, but the more they asked me how I felt the more upset I was getting. Seriously, I am smart enough to know if I was ill – and I was not. I also knew if they cancelled this there was no way they were getting me back any time soon. Since my labs came back and my white count was quite normal, the procedure was a go.
I walked into the ablation room at 8am. After I got comfy on a very tiny table they hooked my IV access up to some fluids which contained some happy potion and I was out. Next I knew it was 2:45pm and two RNs were tending to me as I was trying to make sense of where I was. The nurse reported the procedure was a success, that I would be transferred to my room and would have to lie flat till 8pm. A bit more time was lost because I was moved from recovery to the observation room and don’t recall a thing.
Following a cardiac ablation you have to lie flat, usually 6-8 hours. This is because during the procedure to evaluate and access the areas of the heart that cause the arrhythmia (and in my case the pulmonary veins) is accomplished by inserting a thin catheter (tube) into the vein in the groin. The procedure I had was a cyroballon catheter ablation. and had both the left and right groin used. I had taken care of many patients following ablations, and really thought once I headed to recovery I knew what I was in for.
The next two hours were a blur and a bit scary. At one point I became dizzy, lightheaded then nauseated. As I was trying not to throw up, the RN lowered the head of bed a bit. When she did that the pain in my back increased and I couldn’t breathe. Moving the head of the bed back to 30 degrees (as high as I was allowed to go) helped but now my back & breathing were very uncomfortable. My blood pressure dropped to low 80s/50s (my normal is high 90s/60s).
The cardiologists started to enter. I had start a bedside ultrasound on my chest followed by more labs as well as a bedside echo by both the other doctor as well as the echo tech. Commentary between the doctors is where nursing knowledge is a downside. When they started throwing out phrases like “cardiac tamponade” it spooked me mainly because I knew exactly what the options are if that was the cause of my pain. Thankfully it was nothing serious.
After any serious concerns were ruled out, they gave me a bolus of fluids and things started to improve. My blood pressure perked up a bit and I even felt like eating a bit. (The chicken was amazing!). I dozed off and on during the next few hours, texted some family and friends about my recovery and eventually posted on Facebook that all was well.
My husband went home to be with the boys around 7pm. I still had about an hour till I could move my legs and sit up higher in bed (and then walk!). Minutes felt like hours as the time passed. The next nurse came into the room about half past, introduced herself and quickly got to tend to me dealing with another drop in blood pressure. I felt flush, hot and nauseated again. This time it lasted about only a short time and I recovered quickly. Some jello, rest and a quick nap and finally it was 8pm. I have never been so happy to move in my life.
Slow but sure I was able to sit up without any dizziness and after a quick trip to the bathroom went on a walk around the nursing unit. Once back into bed, my right groin incision started to give some trouble. I might have tweaked something sitting back into bed but the incision site was very painful/tender. No bleeding, no swelling and still soft so things were still ok.
Since I was just an observation patient, the plan was to monitor me overnight and then home in the morning after cardiology rounds. The monitoring consisted on checking the groin wounds, blood pressure and heart rate. The nurse went over discharge instructions as well. No lifting more than 10lbs for a week. Take it easy. Walk up stairs one step at a time. Monitor incision. Take medicine same time each night. Watch for fever or return of irregular heartbeat. Part of the post-op procedure plan is to take a blood thinner for three months. My doctor selected Xarelto (rivaroxaban) as the blood thinner I will be taking. This is something I have ordered for my patients in the past. I had never actually administered the medication and was chuckling that it looked like a ninja star. Kudos to the manufacture for going outside the circle / square box for pill shapes.
By 10pm I had hoped I would get some rest – but just couldn’t. During the procedure they had giving me medication to elevate my heart rate – and it still was hovering between 110-120 beats a minute. No matter what position I placed the bed I wasn’t comfortable. Between the wires, IV sites and call light I felt like I was sleeping with an octopus. It was too bright in the room even with the dim lights for the evening. It made for a long night but thankfully one morning arrived things moved quickly. Rounding at 8am, discharge ready by 830am followed by breakfast, changing out of the hospital gown and walking downstairs to my ride. While morning rush hour was upon us, it was a welcome site to see the downtown traffic as we left the city towards home.
Recovery hasn’t been without a few surprises but the first week has brought a sense of “calm” to my heart rhythm. I was never in A Fib all the time, but over the past year felt like something was amiss more often then not. Thankfully this past week I haven’t felt this way which is a welcome relief. A few more days to recover at home followed by a follow-up appointment at the end of the month and this will hopefully be 100% behind me. This has certainly been its own learning adventure and will add this to my nursing ‘experience’ file.
*Disclaimer: This blog does not provide medical advice. Be advised information provided is opinion & should not be taken as medical advice. There is no substitute for the face to face relationship between a medical provider and patient. See your physician, osteopath, nurse practitioner, or other qualified and licensed health care provider regarding any questions you have about your personal health or medical condition.