As requested, I’ll fulfill the obligation of a lengthy explanation of what happened to me this spring.On April 23, my aorta basically exploded. Technically, it dissected, which means it came apart. Think of what dissection means in biology class. My aorta dissected without any help from a knife.  But thank goodness for tools that fixed it. There are three layers on the aorta, and the inner two layers of mine shredded. Here’s the scoop.

I was in the kitchen, headed to the bedroom to change clothes for a bike ride like any Friday evening, when suddenly, SUDDENLY, my chest hurt like a son of a gun. I doubled over, leaning on the counter and told Tom, “Something’s wrong.” I don’t remember what he asked me first, but he’s well aware of my high pain threshold. So far, the three times I’ve said “something’s wrong” in that manner, it’s been life-threatening, so he was worried. I asked if we should call the cardiologist, and he said that no, we should call 911. I wobbled over to the recliner and sat. He tells me I changed clothes first because I had my favorite shirt on and didn’t want someone in the Emergency Room to cut it off me (Aha. Experience. Been there, had clothes cut off before). I have NO memory of changing clothes. I do remember him asking if he should call 911 and my saying yes, I guessed he should.

Then I remember the first First Responder showing up who happened to be my former student Sheriff Mitch Gahler. I have never been so happy to see a familiar and kind face. I don’t remember much more. I remember saying good bye to Mitch when he left. I remember the ambulance squad coming into the house, and I remember nothing else for three days. 

But Tom has filled in these details for me:

They couldn’t get the stretcher through our door, so they asked if I could walk. I walked out and got on the stretcher and into the ambulance (remember, I have no memory of this). Neighbors have since told me they were relieved to see me walk out the door. That should indicate that nothing life-threatening was happening, correct?  Tom says I was chatting with them like I would normally. I hope I didn’t make a fool of myself! Turns out there was not enough oxygen getting to my brain for memory to kick in; I do hope there was enough oxygen for not sounding like a lunatic.

The ER in Mankato assumed I had a heart attack, but when they scanned my heart, they found no signs of attack and were stymied at first. Tom tells me that I told the ER nurse that my hands and feet were numb and tight. She told the doctor, who then scanned my aorta (“tighness” or numbness in the extremities is a symptom of aortic problems, which makes sense because hands and feet aren’t getting decent blood flow) and then they immediately threw me on the helicopter for Rochester, which the doctor had already alerted to be ready. 

The only vague memory I have here is asking “Where are we?” and being told we were flying over Byron. 

The surgical team wasted no time. By  the time Tom drove to Rochester, I was well into the several-hour surgery. Dr. Stulak and Dr. Pochettino were rock stars. They repaired/replaced the shredded ascending aorta and the aortic arch with dacron, of all things, and teflon in the “root.” A Gore stent graft (think mesh liner like a mesh tube) was placed inside the descending aorta that could be reached through the open aortic arch, because the aorta was dissected all the way up, over the arch, and down the descending pathway. If you want to know more, you can look this stuff up online. 

Coronary Sinus - The Definitive Guide | Biology Dictionary

There are lots of details that I absorb as I read the clinical notes on my patient portal. Shortly after discharge, I was in no emotional place to read it, but I have tried to absorb it in chunks through the summer. They had to cool my body for “circulatory arrest” to do some of the procedure.  This awed me when I read it: “Core cooling was then begun with the goal of achieving flatline EEG.” EEEK. Flatline. If you watch medical shows, you don’t want to read that in your own medical record. That’s a scary thought, but less so since I already survived it. I wonder if that cooling procedure was more advanced than stashing me on ice. I assume so, but I need to ask my cardiologist when I see her. Then after they’ve completed what they need to do, they rewarm the body. I also received 6 units of blood, 3 units of platelets, 4 unites of plasma, and 2 units of something else that I didn’t catch during the course of all this. 

They couldn’t stop all the bleeding, so they couldn’t close up my chest after the repair. (That helps make sense of why I needed so much blood). So instead of closing me up, they packed my chest to leave it open, and placed a strut between the edges of the sawn-open sternum to hold it open. (I realized later that this is the second time I’ve had to have bones sawn in order to receive life-saving surgery. When I count the number of bones I’ve broken in my life, do I count sawn bones? Naw). My sternum was braced open for three days. Obviously, with that going on, they kept me in an induced coma. So that’s why my memory picks up again after three days, and I missed all of this fun. Thank goodness.

What I do remember is having nightmares that I was in the ICU. I vividly saw the windows in my ICU room. Then I must have drifted into some other dream and I remember thinking in my other dream, “Oh, whew, that was only a dream. Well of course, because there’s nothing wrong with me. I’m not in the ICU.” But the nightmare recurred at least four times. Now I wonder if that was when they were checking me for brain function, bringing me to consciousness out of the induced coma for those three days. Tom said they did it about every twelve hours, so that would make sense. I do know that when my eyes fluttered open, everything hurt. A lot. I didn’t come fully awake until they’d wired my sternum shut again and closed my chest, thank goodness, which was sometime three days after this all started.

Then when I finally did wake up, I saw those same ICU windows I had been visiting in my “nightmares.” But this time, they didn’t go away, I did not lapse into a different dream, and it slowly dawned on me that whatever was going on in the ICU was reality. But I still had no idea why, what happened, or how long it had been.

Everything hurt. Too much. And it was too much work to breathe. I remember lying there, hurting so much that I thought it would be easier to just quit breathing. And then I thought about my kids and Tom, and the grandkids. I wanted, needed to see them. Plus I didn’t know what had happened, and I needed to find out what I was doing in this situation, unable to move except my hands and feet and my head a bit. So I kept breathing. Breathing.

Now, looking back, that was a clear decision in my head to keep on keeping on.  

As I became more aware of my surroundings, Tom and Josh appeared. Water in the desert.

I couldn’t speak because of a breathing tube, so I gestured for a pen. I couldn’t see the paper with all the paraphernalia in and above my chest,  so I wrote from muscle memory, “Where?”

They answered “Mayo in Rochester.”

“What” I wrote.

They answered, “You mean what happened? You had open heart surgery.”

I could feel my eyes flying wide.

“Your aorta dissected, or basically shredded,” they said. “And the surgeons fixed it.”

When I got over that shock, I wrote “How…” 

They asked, “How long?” I nodded.

“Three days,” they said. They laughed at my shocked reaction. 

The nurse asked me if I was in pain and I wrote “ES-Y” but tried to put the Y in front of the E as an afterthought. 

It was a lot to take in, but Tom and Josh were there. And they told me Nikki was flying in at the end of the week, as soon as she could. 

When my breathing tube finally came out, I could talk, but my throat felt sore for a long, long time, even after I got home. The ICU nurse kept reminding me to breathe. “In through the nose, out through the mouth, nice and easy.” It was still too much work, and I occasionally thought of quitting, but by then, I knew Tom was there and Josh was there, and quitting was no longer appealing. I wanted to keep going on.

The surgeon explained that the aorta has three layers, and the inner two were shredded. I can only imagine what would have happened if the third one split. I certainly wouldn’t be here any more to write this. I feel inordinately fortunate. It’s the understatement of the millennium for me to say I’m grateful to be alive. 
The surgeon also made some references like “serious” and “touch-and-go” and “dramatic,” but those were all words I heard later, not at the time.
I was in ICU and then a regular cardiac room for a total of ten days. Every day was tough, but every day was at least a tiny bit easier. At first, standing was excruciating. Then taking two steps felt insurmountable, then doable. Then I walked farther than the door of my room. When I worked harder, the next day, I was exhausted. But the general trajectory was in the right direction. By the time I left the hospital, I could walk–with help–and with a walker–around the “block” of the hall without having to sit down.
Nikki came, and I had a few blessed days with both my kids. Only two visitors at a time were allowed in my room, so Tom stayed home to allow them that freedom and to make sure the guest room was set up for Nikki. Bless his heart. Not only did he save my life. AGAIN. But he’s just at trooper in every way.
Coming home, I could barely walk across the floor to the bathroom without feeling like I I might pass out. I couldn’t have been more grateful that Nikki came and spent ten days with us after my discharge. It made all the difference in the world.
It was a long, slow haul to start to feel normal again. I still don’t feel “normal,” but I feel good. Most of the time.
For the first time in my memory (except after my brain aneurysm, but that’s a different situation), I had no choice but to sit down and take significant rests. I mean RESTS. In the recliner. For perhaps an hour. This is life-changing. I’m used to going early morning until late in the evening, eating lunch at my desk and bouncing directly from the drive home from school out onto my bike. This is a different way to live, but I’m adjusting. 
I’ve been told by my cardiologist (medical cardiologist vs. surgical, so she will be my ongoing care-giver) that I can no longer do anything vigorous or rigorous or strenuous. Doing so can raise my blood pressure, which can cause the descending aorta (around the mesh stent) to puff with exertion. That could lead to explosion and of course, that would kill me. That’s enough warning to take all this to heart. Literally and figuratively. 
So everything I do, needs to be done “in moderation.” I have not been known to be happy with moderation in much that I do. This is a failing–I’m not proud of it, but I equate moderation with mediocrity, and that’s not something I’ve ever been willing to swallow. Well, maybe in keeping my office clean. Or other rooms. Some friends would argue that even that I don’t do in moderation. It’s either a mess or it’s spic and span. 
What have I learned? That I really, really do want to stay alive for a good long time. I want to spend years with Tom, and I want to see my grandkids graduate from high school and maybe get married. There are people I love, love spending time with, and I want to get to do that. 
So what does that mean? It means that I’m shifting my identity. I don’t mean my public, social media persona. I am shifting how I think of myself. 
I have been a cyclist since 1997. That’s been how I think of myself, and how I spend whatever time I have for “leisure,” with friends or by myself. But being a cyclist means exertion. I’ve ridden hard. Not always, of course, but hard enough, frequently enough, to go on big group rides that move along, to train for races, and for long endurance rides. I don’t really know how to be a cyclist in moderation. I’m sure it can happen. I can ride my fat bike through the woods, or I can cruise down the trail, but that’s not what riding has meant to me for twenty-four years, so I don’t know how to adjust to that yet. Until I am confident in my psyche that I can, which isn’t going to happen this season, I’m avoiding cycling at all. Partly by my own decision, but also because my kids have requested it. Tom is relieved, too. 
And so, I’ve become an ardent walker and hiker. Daily, with a day off here and there. I’ve fallen in love with moving through the world at a slower pace and seeing much more than I ever do on the bike. And Tom goes with me sometimes. And I have friends who willingly walk with me. Most of the time, however, I go alone. We’ve seen dozens of deer, including the triplets and their mama who live in the woods very near our property. We’ve seen turkeys, a racoon, hawks, eagles, bluebirds, meadowlarks, and more. I’m hooked, and it’s a slower pace. I can adjust. See? 
I also retired after spring semester and my disastrous end-of-school-year-in-the-hospital so I didn’t get to finish out the year with my last groups of students. That part was very sad. Not grading research papers was not as sad. But it was very sad for the accommodating friends and fellow faculty members who stepped in and graded for me in spite of their own work to do. So I felt like that was a very anti-climactic ending to a long career. 
But the bottom line is that now I’m retired, and this is the first August I don’t have to gear up for and prep for four classes to teach. That part is just fine with me.  It also allows helps immensely in this effort to slow down. I’m not minding that part. Resting is rather satisfying, it turns out. I’m reading voraciously and I’m finally writing again. Writing isn’t resting, but it doesn’t exhaust me physically like some things do.
Besides walking and hiking, I’ve also begun a shaky practice of Tai Chi –fusion with yoga. I think this is another good thing. And going to cardiac rehab once or twice a week has gotten me firmly back into lifting weights. It’s absolutely gratifying to work with exercise physiologists who really know their stuff!
I’m trying hard to just pay attention. And to be brave. Some of these changes haven’t been easy, and sometimes I need to remind myself to be brave. So there I go, into this next chapter of my life, trying to be brave. 
Becky Avatar

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