Jijibisha- The Will To Live

I lay in the darkness, my searching eyes looking out for familiar faces but all I could see was the blinking red, green lights and the beeping of monitors. I tried to move desperately but couldn’t. I was confused. I was in pain. I felt groggy and nauseated, and my stomach felt queasy. I also noticed that I could not swallow or speak because of the tube placed in my throat to help me breathe. When my eyes adjusted to the faint light I saw saline bottles hanging and the dripping liquid going through the needle inserted in my body. Gradually I deciphered what had happened with me and it sent a chill down my spine. I had gone under the knife to experience the mother of all surgeries--the coronary bypass.

Lying on the bed of the recovery room I tried to comprehend why and how I landed up being in this stage. It was a hot afternoon in May 2016, and for the second time in a week, I was seated in the office of a prominent cardiologist in my home town. I was bewildered as to why I was there.

Five days earlier, I had been to see my family doctor about what I thought was a bronchial problem. For about a month, I had experienced shortness of breath and a low-grade but nagging chest pain as I warmed up to exercise. The pain was dull, more like a feeling of fullness or pressure. By the end of the warm-up, it would usually disappear. I ignored the pain, hoping it would just go away. But one day, it remained with me throughout the day. It was then that I decided to call him.

“I've probably got an attack of bronchitis,” I told him. He asked me to come in right away. I had seen him just 4 months earlier for an annual physical check-up and the results then were excellent, so I was not expecting anything more than a short visit and perhaps a prescription.

The examination indicated that my lungs were fine. The results of an electrocardiogram (ECG), however, were not. A previous electrocardiogram had been performed just 4 months earlier, and the results than had been normal. The results now, however, were drastically different. “Mr. Raj, the test indicates a possible obstruction of the coronary artery,” my doctor said. “I want you to see a cardiologist immediately, today.” So, three hours after my “routine” examination, I found myself undergoing a thorough cardiac examination and an exercise stress test. I did not take seeing a cardiologist lightly. But I did not believe there was anything seriously wrong, either; I was certain it was a mistake.

Like the electrocardiogram, the results of the stress test indicated a problem. I subsequently had coronary angiography that indicated three arterial blockages ranging from 80% to 100%. “You have CHD(coronary heart disease),” the cardiologist said”. I was shown the pictures of my heart, clearly indicating four blockages to the coronary arteries. “I recommend coronary bypass surgery be done within the next few days.”

His words hit me like a thunderbolt. This couldn't happen to me. I was not prepared to hear what he had to say; I had difficulty understanding. He was speaking about a heart problem—my heart problem!—that psychologically I could not accept. Thoughts of escape filled my mind. “Just get up and leave,” I told myself. “It's all a mistake. You're not supposed to be here.” Once safely back in my world, I reasoned, I would surely awaken from this horrible nightmare.

As I continued to listen numbly to the doctor, I was confused. Like most people, I knew something about the workings of the heart and the coronary arteries, but the information was chiefly of the Biology 101 variety. It was not that information about the heart and heart disease was not available. But, quite frankly, it had been of remote interest to me. Such information, indeed the subject itself, was simply not relevant to my life. What did blocked arteries or heart attacks have to do with me, a healthy man with no major ailments even at the age of 60?

Unknowingly, I had succumbed to the “what I don't know won't hurt me” syndrome. In reality, what I didn't know could not only hurt me, it could kill me.

What I didn't know was that CHD usually develops silently, insidiously, over a long period of time. Once it surfaces, however, the primary result, a heart attack, is often immediately devastating. What I didn't know was that for about one-third of heart attack victims, the first heart attack was the only one, resulting in sudden cardiac death. What I didn't know was that while genetic history is important, most people with heart disease have it because of poor lifestyle habits involving diet, exercise, stress, and smoking. But conversely, improving those habits could contribute to better cardiac health.

Such information was simply outside the realm of my everyday life. But it all changed for me on that May afternoon. As the diagnosis sank in, I was gripped by pure stomach-churning fear. The concept of death had been a remote one. I pictured it at the end of a long life, after years of accomplishment, fulfillment, and joy. Old age was something that I looked forward to sharing with my wife. I had never contemplated the idea of death taking me in my 60s.

On that Mayday, the alarm clock of reality rang. I realized that not only could death happen now, but also it probably would happen now, the result of a time bomb located inside my chest. My wife and son were too shocked to believe that a healthy person as me had CHD.

A decision was made to undergo coronary bypass surgery. On the day of the operation, I had an injection to relax me and a shot to put me out. I stayed there until the next day and was then taken to the Operation Theatre. Cardiac surgeon Dr. Bhatnagar was flown in from Hyderabad to perform the surgery. I had gone cold and numb with fear when I saw masked men surrounded me. As they talked to me, I saw blurred images and I slipped into a deep slumber.

And here I was, now lying on the bed in the recovery room covered in drains, wires, and drips with a team of caring nurses and doctors at my beck and call. Throughout the day every day, I was on medicines and injections. I felt weak and completely drained out as I was put on a liquid diet, gradually putting me on a semi-solid diet. The third day I was shifted to the ward. They try to get you to act quickly. I sat in the chair while they made my bed. After three days I was walking around my bed and I gradually got stronger and stronger. Six days after the operation the physio came and checked. After I had proved I could walk up and down two flights of stairs, I was discharged. I went home to recover, elated simply to be alive and with my family again. But I was very concerned about my future. Surgery had circumvented the immediate problem—having a heart attack—but had not stopped the disease. Bypass did not “cure” me. As my doctor counseled, “You had heart disease the day before surgery, you had heart disease the day after surgery, and you have it today as well. The surgery took away the pain but it did not remove the disease. Only a change in your lifestyle habits can reduce your future heart attack risk.”

The first day home from the hospital, I felt helpless. I was in bed and could not get up. It was very depressing to not be able to do the things I had always done. You feel sorry for yourself. To me, my main depression was a sense of helplessness. Before my first visit to the cardiologist, I was in pretty good shape. I was working out, not overweight. In fact, I had just been on a ten-day vacation with my wife.

I was never teary. It was more of apathy. The degree to which I felt tired was beyond what it should have been from a physical standpoint. Being helpless was the worst phase of my life. I saw my wife and son slog day and night on the jobs that I did.

I am not a super outgoing person. I tend to be more to myself, but bypass surgery exacerbated this. Regaining emotional strength is a tougher challenge than recuperating physically. My wife would leave for work, and I would just feel sad all of the time. I didn't want to do anything, not even shave. I would tell my wife that she needed to take care of me. She spent sleepless nights as much as me balancing between her job and my care, post-operation. She too was affected in a big way. She loves me and so carried out her duties putting on a cheerful smile. My son stood by me like a solid rock. He took the reins in his hands and set right the drowning sails. Mental fatigue and overwhelming sadness struck me. I think I was depressed because all of a sudden I would burst out crying. I told the doctors about the depression, and they said it was a normal thing and I'd get over it. I did, but it was still very emotional when it happened. I was not myself.

A fortnight passed after the operation when something happened that scared me out of my wits. That morning as I got up to brush I spat blood from my mouth! Fear gripped me in its arms. Stark terror took a firm hold of me. I rushed in a panic state and showed it to my wife and son. They immediately rushed me to the hospital. On examination, it was concluded that the oozing blood had nothing to do with the heart. The operation was successfully done. I was advised to go for a dental check-up. I had no option but to go to the dentist. The dentist thoroughly checked my teeth and told me about a tooth infection and that tooth extraction was the only solution. The thought of again going in for another surgery made me almost insane. My suicidal thoughts became stronger. Oh God! Why was it happening with me? Why god why?

At that time, I had all of my family with me -- my brother, my 84-year-old mother, my children, and my wife, of course. That did help quite a bit because they were always with me. They tried to get my spirits up, but who likes to be cut up?

The nightmare called tooth extraction was finally done with number of pre- and post-operative sittings which left me exasperated! Every morning checking for any abnormalities in the mouth went on for a week and then gradually stopped as the healing of the operated area brought relief to me.

And then one day, I don't know what happened, but something took hold of me and I just told myself that I had to get a hobby or something. I started gardening. I have a pretty big lawn and I got saplings and planted them, watering them every morning. I put up a swing and would sit in the evenings reading a book. I found pleasure in reading books. After I started this hobby, my whole life turned around. I never got to the point of feeling suicidal, but I tell you if I hadn't gotten a hobby or become deeply involved in something, there was a good chance. My Jijibisha (the will to live) intensified with each passing day. Now I'm busy all day long and at no time do I stay alone to myself. So my secret to anybody with open heart surgery is to become involved with something after the operation.

I was keen to start rehabilitation as soon as possible, so decided to start walking the next day. I stepped out on the gravel outside my house and arrived gasping and shaking at next door’s gatepost. Not a step further could I go. Chastened, I almost crawled back into the house. This would require some thought. I mapped out a program for myself and started grimly the next day. Ten yards out and ten yards back for a couple of days, then doubling it up every day until I reached the end of the lane. It was a good month or two before I got myself out of the house. It took a little time until I could cough without discomfort, but - apart from feeling like a sandwich board advertising man with a great heavy lump of board fixed to my chest - I felt weak, but fully functioning. I was determined to keep active, and once I returned to work, walked every day. At weekends I and my wife drove to a flat road and started timed walking, starting by walking with ten minutes along and ten minutes back, and gradually increasing it. We also resolved to keep to a strict diet, which stands us in good stead to this day.

A few months after the surgery, I decided it was time to tackle “the mountain” – the six-mile walk ending in a steep hill of about half a mile. As I set out on the first section, I expected any minute to feel the old stab in the chest but miracle of miracles, I arrived in fine fettle. When I got to the top, I was only a little puffed, with my heart beating a smooth and confident 70 to the minute. We practically galloped the last bit and headed for home, lunch, and some celebratory wine.”

My thanks go out to all the wonderful medical staff concerned in this tale, their cheerful and always confident attitude to their roles in my resurrection.

I am a believer in the efficacy of healthy lifestyle choices for the primary and secondary prevention of coronary heart disease (CHD). As a result, I make a serious effort to eat healthily, exercise effectively, manage stress, avoid cigarette smoke, and keep a positive attitude. Looking back on my life, I would love to tell you that my commitment to healthy living was the result of native intelligence, but it was not. Instead, it was born out of need.

Sure, there were things that could have been improved. My cholesterol was too high, I could stand to lose a few pounds, and my exercise regimen was sporadic. There would be time, I thought, to improve my numbers and my health in the future. But I was wrong.

I saw my lipid specialist after the surgery for advice on how to manage my cholesterol. “Should I change my diet, maybe increase my exercise?” I asked. “Don't bother,” was his reply. “You have an aggressive form of CHD an age one can’t tell. Frankly, I'd be surprised if you live longer. The chances are slim.”

While his bedside manner was harsh, I had to acknowledge that he might be right. For a week or two, I was depressed, unable to see a clear path or take decisive action. Then my wife put it all into perspective: “His prediction is not predestination,” she said. “It's true, you can't change the cards you were dealt. You have aggressive heart disease. But you can change the way that you play those cards. And we are going to do everything possible to eat healthier and exercise more effectively to even up the odds.” And that is what we have done.

No one has the ability to influence patient behavior more than physicians do. How many anecdotes have we heard about the heart patient who continues to smoke because “my doctor never told me to stop”? So, while it is easy to become enthralled with the science of cardiac health—new medications, robotic surgery, and coronary inflammation, for instance—helping the patient create a healthier lifestyle is the core issue. It is fine to give the patient a 4-inch-thick study on cholesterol, but what does he do when he goes to the refrigerator? The science of healthy living needs a practical application for it to help patients.

Making healthy changes to benefit health is simple—not easy, but simple. Many people can become discouraged, particularly if they have a lot to change or feel pressure to do it all at once. Make changes just for today. Don't fret about yesterday; it's over and you can't call it back. Don't be concerned with tomorrow, as it is not yet here. Instead, make a commitment to live healthy just for today. Pretty soon, the days will add up to weeks, months, and years, and changes will become habits. That's what I’m doing.

My bypass experience has become the motivating force for me to understand the impact of lifestyle habits on health and to take action to improve them. I want to share my story with all those who underwent a similar experience as me and have been graced with an opportunity to live and reach out to those who are leading a faulty lifestyle.

In retrospect, it was a hard way to learn important lessons. What I had to be taught for rehabilitation I could have learned for prevention.