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Flat Line… (My Personal Account)

18 Jan

This is the updated narrative of what transpired during my brief demise last year…

December 21, 2012 was predicted as the end of the world as far as the Mayan Calendar is concerned. Well, I went ahead… on the 8th of December… The feast of Immaculate Conception Day.

But my valiant heroes did their best to resurrect me. I survived my own apocalypse so here I am now, sharing my story.

Before anything else, before you can understand everything, I suggest you to read my previous blog Personal Struggle – Lifestyle Check on August 5, 2012…

One thing conspicuous about me days before my demise was that I looked bloated. I didn’t acknowledge that nor even considered it happening to me because I was on a no-rice diet for about two months already. I can’t deny it though, the recent pictures I had loudly reflected it… I have become fatter!

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I had been running on the treadmill with increasing duration. After 2-3 mins run, I decrease the speed and continue walking for a full minute. I never stopped to catch some breath. Then resume running again. This has been my cardio workout weeks before the incident. Aside from this, I do some weight lifting, following a routine prepared by my gym instructor.

On December 4 of 11 pm, I drove down to Manila to attend the PPS Christmas party where they will induct new diplomates and fellows, including me. December 6 was the supposed induction ceremonies but alas, due to traffic, I wasn’t able to make it to my own induction. What a shame.

I spent one more night in Manila where I met up again with my fellow RH supporters at Slice High where Sen Pia Cayetano gave us an update of how the senators supported it. We were treated to healthy food and delicious cakes.

On December 8, 7 am, I checked out of my hotel, had the valet get my car then drove back to Baguio. I did not eat breakfast as I was running late. I was aiming to reach Baguio by noon time because I had some patients following-up. By 9:30 am, I reached Paniqui, Tarlac Shell station, where I had a quick breakfast of sandwich and soda. When I had my fill, I resumed driving. On my way up, I opted Kennon Road, which is the shortest route to Baguio from Rosario, La Union. I arrived at my clinic by 1 pm. I decided not to go home anymore as it will take more time and might be too late for my clinic hours. I had my lunch at the hospital canteen then I proceeded to my office for patient consultation. Well, since I got no time to change, I was on my sports wear.

At 4:30pm, I finished with my work. I rounded my in-patient at the NICU and since it was still early before our Christmas party later in the evening I went home to rest. In fact, I had some nap. Well, I was rested already, stress already relieved, ain’t it? I then prepped for our Christmas Party at Pines City Doctors’ Hospital. (This was where I was born by the way). Since our dance required me to be on a Ricky Martin costume, I donned a shimmering black slim fit shirt and slim fit black pants as well. I fancied to use my designer belt and a glossy black shoes. Not really a Ricky Martin-ish ensemble but it was the closest I could have based on what I have in my closet that time; I did not have time to shop for it.

I drove to the hospital and when I arrived my group mates (fellow Pediatricians) were rehearsing. I joined them to recall the choreography. I had some dinner after that. I took small portions of some of the food served and ate a little as it would be difficult to perform with a full stomach. There was lechon, but as I was on a diet then, I did not taste it. We were third to present. The two first groups were incredible. And since our routine did not have a touch of Christmas, which was part of the criteria, I just thought of just dancing as if no one was watching; maybe it would do better for my group. I handed my jacket, phone and ipad to my friend Dr Rhoda. Was I tired? Was there chest pain? None at all, I was just nervous and I felt light.

While we were dancing, As I always would, I was just looking at the head of the spectators so I wont be conscious of my movements. I was having eye-to-eye contact with the judges and tried to give my all, as were my other groupmates. Accordingly, Mr Raymundo Benedito, husband of Dr Leony Benedito (an OB-Gyn) and Dra Suanding (OB-Gyn) noticed that while I was dancing, my face looked defaced. They also saw something… my soul was departing from my body. With such scene, they say it is inevitable that I will die. One way to prevent this is to shout the person’s name to come back. Thus they started shouting “Clinton, bumalik ka.” They were screaming, but I never heard them. The cheers from the audience were loud equally and drowned their call. Dr Rhoda on the other hand, who was enjoying my performance, was shouting “Go Clinton!” (Did these opposite beckoning confuse my soul whom to follow?) Others also noted that I seemed to have slackened towards the later part of the dance. But for me, I never experienced nor felt anything unusual.

And then… all of a sudden, I raised my hand and fell to the ground, my head dribbled on the concrete. My groupmate at my back, Dr Liza shouted to Dr Efren I was having seizure, then closed my eyes. Meanwhile, the audience were thinking that was a part of the dance, an act… that I will be lifted by my groupmates at the end… but they were mistaken as there were only two of us guys in the dance, so my female colleagues wont be doing that. They were waiting for that “lift.” It never came.

Dr Sophia Black, who was at the end of the hall, noted that I was cyanotic (bluish). She rushed to the stage and felt my carotid pulse. There was none. It was a sudden CARDIAC ARREST (heart attack). I have no heart beat. I was a goner, DEAD. Immediately she called for a CODE. This then pulled everybody back to their senses and started to move. The cardiologists present at that time at that venue, Dr Justina Calibuso (my brilliant batch mate), Dr Helenne Joie Brown (younger colleague), and Dr George Pangwi (one of my mentors) immediately did cardiopulmonary resuscitation. Some rushed to the emergency room to get the crash cart and defibrillator. (Unfortunately, there was a prior arrest at the emergency room, just before me thus the defibrillator was not fully charge). After two shocks, the defibrillator machine got drained. There was no electrical outlet at the venue and thus it can’t be plugged. Thus, my rescuers were manually pumping my heart. They must be very precise with the way they pumped because: 1) they were able to maintain good blood flow to my brain, and 2) I never had rib fracture afterwards. (As an effect, they were able to preserve my brain functions to normalcy. Conversely, if it had been a male who pumped my heart, I could have had rib fractures, Lucky me!) Dr Efren, I was told, gave me quick breaths, in between the cardiac massages. (Dont worry sir, I was still dead that time, I cant remember it how it felt hahaha). Dr. Cristy Marrero was able to insert endotracheal tube into my trachea for air to pass through into my lungs while I still cannot breath spontaneously. After almost 30 minutes, my heart resumed pumping, but it was weak. I was in severe cardiogenic shock, and my life was heavily dependent on the medication drips. or else, I would go back to death. I was then brought to the emergency room afterwards.

While the resuscitation was ongoing, Dr Norma Batnag called on Isabel Rosario (a cusin), who in turn called my younger brother. Good thing my brother was home that time (as he has his own apartment) that he was able to inform my parents immediately of what happened. My brother Lawrence then went to the hospital immediately, then my mother followed a little later. Dr Rhoda also called up Dr Myra Estrada (my colleague/kumare/batchmate during residency) who was with her sons. Upon learning what happened to me, she really thought I was a goner, dead for good, that her knees weakened, she sat on the floor. She then rushed to the emergency room to my rescue. She called up another friend and batchmate during residency, Dr Joselito Domingo, who was skeptic and didn’t believe what he heard. He even said “ginu-good time mo ba ako?” As he knows I am one fit lad who never misses a day in the gym working out. He then followed to the hospital as well. Dr Cathy Gomez (my chairman of Dept of Pediatrics at SLU-HSH, and my “mother” during residency– I was her “first child,” first graduate of residency when she became chairman of the department) was also notified of what happened, she left the party she was at and then came to the hospital to attend to me. Word went like wildfire, viral, and everyone who learned of the incident started praying for me. The universe must have moved in unison to bring me back… to LIFE.

Blood was drawn for some test and for a strange reason my potassium, calcium and magnesium were abnormally low, especially my potassium. (Well my drug intakes only were orlistat, hydroxycat-fat burner, fenofibrate and ruosovastatin; all directed to my lipid problem — high total and LDL cholesterol and triglycerides, and very low HDL).

Two-dimension (2D) echocardiography showed my heart’s septum was not contracting, confirming a myocardial infarction (heart attack) and thus needing a further angiography. My left ventricle ejection fraction was only 50%. Dr Jing and Dr Helenne went to Notre Dame de Chartres Hospital to set up the Cath lab. Dr Arlene Baguilat (fellow Pediatrician) called up Sr Adelina (hospital administrator) regarding the plan. Sr Cora, the nursing service director then mobilized all those on duty and set-up the Cath Lab. Meanwhile, they had to check my head as it hit the concrete ground big time when I fell. Luckily my head CT Scan result only revealed cerebral (brain) edema; no hemorrhage or fracture. Again, Lucky (bastard) me!

I was then transferred to NDCH immediately. Dr Pia and Dr Myra took turns bagging me while in transit. My bunch of keys was given to my brother so he and my mom followed using my car. Other doctors too followed. My entourage was a large group. It was as though it was my funeral, but the difference was, I was alive and headed to the hospital, not my resting place. 🙂 The hospital atmosphere was very tense at that moment. Everyone wanted to take part in my care. I was immediately brought to the Cath lab. Swan ganz catheter was inserted. Angiography revealed I had 2 coronary arteries that were completely blocked and another one about 20% obstructed. Stenting was attempted on the blocked coronaries and the obstruction was too hardened that insisting doing such may just throw and embolus that could cause pulmonary embolism or stroke at the worst. This thus mean that the obstruction had been a chronic phenomenon, perhaps as early as childhood. If I had two arteries completely blocked, that had been obstructed for a long time, then how come my previous ECG always were normal? How come I did not have the heart attack years ago, why only now? How come I am still alive up to this point? Because usually, even incomplete obstruction would already bring about significant symptoms like chest pains, or shortness of breath. (Well, there were occasions in the past where I had to catch up my breaths during some dance routines or spin classes, but no chest pain at all). The angiogram revealed another surprising findings. There were several collateral vessels that had been responsible in conveying blood to the parts of my heart not supplied by those blocked arteries, for a long duration now. These multiple collateral vessels had been my life saver. They were the reasons why those ECGs I had were normal. They were the reasons I was still alive. One thing that was puzzling was, how come I had the attack only now that I was just doing a not so strenuous activity. I had been doing spin class, latin ballroom competition, which were more rigorous than the dance routine we were having during the program, and yet they never triggered an attack. Why only now? I still can’t answer this until now. I badly needed a by-pass operation to correct everything, and for me to survive.

When these were the findings of my angiography, Sr Adelina then called up on the team of cardiac surgeons and perfusionists to come to Baguio for the emergency procedure. They were on their way already to Manila, Tarlac to be exact, when the call arrived. They came back for me! Meanwhile, I was already transferred to my ICU room, while waiting for the team to arrive. I was in severe cardiogenic shock that my blood pressure was fluctuating rapidly; the residents monitoring me had to be up all night. If they will increase my sedation, my blood pressure drops rapidly; if the decrease my sedation to raise my BP, I become restless and combative and want to pull out all my contraptions. They really had to keep on adjusting my drips.

I had been vomiting a lot, projectile. The nurses would clean me up, then I’d just vomit all over again afterwards. I was still struggling, they were saying I wanted to pull out my endotracheal tube. I cant remember these details that were being retold to me. But what I remember was I wrote in a paper that I want it pulled out by a few centimeters as I could feel it was lodged more on the right main bronchus. I think Dr Ruel Revilla said, “Clinton, hindi ka doctor, pasyente ka muna ngayon.” I kept on signaling I want to write to communicate. One I remember being asked by Dr Pia: “Clinton kumusta ka na? Nasa Notre Dame ka, nag-arrest ka, narevive ka namin.” Then I replied “Lintek na sayaw yan.” When I replied that, that made my team of doctors think my brain function must be intact. This made them feel jubilant and gave them a sigh of relief; they reassured and they gave my next of kin a sense of hope. I also remember writing “I want to pee!” (Yes, with an exclamation point). Then someone inserted an indwelling foley catheter, but I cannot recall who did it. I got a surprise, though I wasn’t aware. Staff of Cong. Mark Cojuangco arrived to check on my status. I dont know how they learned of my condition though. It must have been through twitter. They advised my family to limit visitors as this will help significantly in my recovery.

I was sedated heavily. I was given midazolam, then propofol, then sevoflurane, then precedex. I think it was the latter that was administered last, finally I got knocked out entirely. (Whatever happened next, I can’t remember a single thing and the following anecdotes were from my friends and family who witnessed the goings on.)

While my angiography was going on, Dr Raymund Oribio and Dr Rhoda Orallo facilitated securing blood that I will be using for my intended operation.He called up the laboratory for any available blood, he also called up SLU-Hospital of the Sacred Heart for any possible donors. The personnel at the information were shocked when they learned what happened to me. They helped locate potential donors, most of them were medical students (some of the names I was able to gather were Dr Giovanni Balangay, Dr delvyne Agsalud, Dr Karol Villanueva, Dr David Dumaup, Dr Philip Parilla, Mr Arca — husband of one of my Pedia residents Dr Rowena Arca. Sorry if I missed anyone, please let me know). This help by Dr Oribio and Dr Orallo was such a big relief on the part of my family, who did not know what next step to do, who were still confused and shocked and were merely moving like minions, based on what they were being told. Several friends arrived to see how I was doing. (This included Ms Rina, Ms Rose, Lua, Ate Len. Lua then called up Ate Dindin who in turn informed Guion and Kylie. Guion apparently cried at my condition. Anton Broas also called my brother and indeed confirmed the news; he cried – I was touched to learn about this). Several colleagues followed my ambulance thus two sections of the hospitals had to be opened to accommodate them all, weary and anxious on what my status was and will be.

December 9, Sunday was the day I was operated on (open heart – bypass operation). When one of the anesthesiologist saw my face at the anesthesia room, she told Sr Cora (Nursing Service Director), “Sr, ay ang gwapo naman niya.” (Pagbigyan nyo na ako. Inulit ulit ni Sr sinabi sa akin to e). At 9:40 am, I was already under the knife. The vessel to be used as a graft could either be the internal mammary artery at the left (LIMA) side of my chest, or the saphenous vein from my legs. Between the two, studies has shown that the LIMA has longer patency, of about 15 to 20 years. But harvesting this would be tedious and will take a long time. Another factor considered was that I underwent cardiac pumping, so there might be a possibility that this vessel might have been injured during such procedure. And my case was an emergency, I was in severe cardiogenic shock. There was no luxury of time to harvest LIMA, so they decided to use the greater saphenous vein from my left leg-thigh (leaving my then-flawless legs five scars).

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They connected one end of the vessel to the aorta, the other end to the areas where there was no blood supply. While the operation was being carried out, my blood was shunted to a heart-lung machine. When they thought I was ready, they switched the machine off for the first time. But on that first attempt, my heart didn’t contract yet. So they had to rehook me again to the heart-lung machine and do the necessary corrective measures. After the second “off” lo and behold, my heart started to work. Thus, my operation was over at 2:00 pm. And yes, this was the incision done…

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I was then wheeled to the recovery room, which was adjacent to the cardiac operating unit. Still I was sedated thus I can’t recall anything yet. My cardiologists and residents never left my side until they made sure I was stable. I only woke up the next day, Monday, no longer in shock, and thus my cardiac support were then discontinued or decreased one after the other. My gaze was still blurred so I had to ask persons talking to me to approach closer. I was already conscious at this time but feeling weak, I’d easily doze off. I thought that when I woke up, it was just a few minutes after our dance and thinking this way, I was afraid to inform my mother of what happened to me as her blood pressure might shoot up and cause another problem. When Sr Cora asked me who would I allow inside to see me now that I have awaken (from over 24 hrs of sedation), I did not include my mother. Funny, I did not know that my mother already knew my condition and saw what happened, she even consented my procedures. My siblings dropped by but briefly. Then when Dra Pia walked in, that’s when I only learned that I had an arrest, then underwent bypass graft operation. Strangely, I did not get sad nor cried at what happened to me, (I dont know why because bottomline is, my present condition is already depressing); I am already a person with disability (PWD). I got to learn that Manny Pacquiao lost his latest by knockout. On this day I was still asleep most of the time but would easily awaken when someone steps into my unit. I was thirsty and bugged my nurse to allow me sip water from water-soaked cotton ball, frequently.

Tuesday, 2nd post-op day… I was already drinking water from cup, and to think i still have that endotracheal tube on my trachea or maybe I was stubborn to insist that I want to drink. I think that’s a talent. My cardiologists just grin when they see me drinking as I was really really thirsty. Noting that I was getting better, they decided to remove the endotracheal tube on the same day, and in the afternoon, I was transferred to the ICU. I was on oxygen by mask. There was this separation anxiety from the recovery room, but on the positive side, it only means I am now better enough to be in the recovery room still. Sr Cora was still rigid on screening and restricting visitors to my attendings only. Even the medical directors of other hospitals who wanted to see me were barred. While it sound that the “no-visitors” policy was too strict, I finally came to learn the rationale when Sr Norma (head of Laboratories and Diagnostics) told me. They observed that most of the by-pass patients usually become toxic 48hours after surgery, usually from infection. While my would-be visitors may be hating the policy, it was done all for my own good.

My new room was a private room with ICU set-up. My nurses came from the ICU too. They were so patient with me and was treated a VIP. But I did not take that opportunity to be bitching. Mind you, I always had 2 nurses per shift despite the fact that I was behaving well, yes I was not a difficult patient. Even when the medical technologist had to repeat extraction as they did not hit my vein right at the first attempt, I didn’t bitch. I even showed them which vessel to extract next from. There was also an instance when both of my IV lines were out, the nurse had difficulty finding my vein, she punctured my veins several times but did not hit it, I never got mad and demanded for an expert phlebotomist. My laboratories at this time showed I still have low potassium and calcium levels. My creatinine was elevated and I already was informed that if it reaches this certain level, I might undergo dialysis. My blood sugar too was strictly monitored to a certain level only as an elevated level might hinder my wound healing. Before the night shift was over, my nurses would do my morning care and dress my wound. I was till not allowed to receive visitors, even my family would just peep and see what I need.

Well, did I mention I had 18 attending physicians? Yes, 18 — 3 cardiac surgeons (Dr E Aleta, Dr J Bautista, Dr R Hojilla), 3 anesthesiologists (Dr L Revilla, Dr F Valentino, Dr J Tabingan), 3 cardiologists (Dr S Black, Dr J Calibuso, Dr H Brown), 3 pulmonologist (Dr R Revilla, Dr J Nigos, Dr K Eustaquio), endocrinologist (Dr R Oribio), gastroenterologist (Dr FW Antonio), nephrologist (Dr V Untalan), neurologist (Dr R Fangonilo), infectious disease (Dr Orallo), rehab medicine (Dr J Capistrano). (All of them volunteered their services for free!)

Wednesday, 3rd day post-op. My breathing was labored according to my attendings. I was having pulmonary congestion, I was still swollen, especially at the site where the graft was harvested. I had to wear compression stockings to decrease that swelling of my left lower extremity. My albumin was low, probably explaining why I had fluids all over, but less of it perfusing my kidneys. I was then administered albumin and was diuresed simultaneously (just as how I do with my younglings in the NICU). I think I already started eating this time, but I would only touch the fruits and nothing else. My appetite was still bad.

Thursday, 4th post-op day… It was noted that my lungs were clearer now and my breathing was much better than the previous day. My creatinine also improved dramatically. I already started having stools and I feel so indebted yet louche that my nurse had to clean me up. Well, since my family were not allowed still to stay in my room, then they were the ones doing such chores. Even bathing me, shampooing my hair, it was their job! I came to learn and appreciate all the more, as a patient, how difficult it is to be a nurse.

Friday, 5th post-op day… It was a day of good news! I was discharged from the ICU and transferred now to a regular room. My diet was upgraded, and my family can now be with me. My cardiologists initially limited my visitors to close family only, but upon realizing the throngs of colleagues and friends who really wanted to check on me, she removed the sign and allowed everyone to come and see me. It was also on this day when I had my first real bath (in the bathroom, not on the bed) – what a feeling it gave me. And I was referred to Rehabilitation Medicine for my Cardiac rehab!

On my first week post-op, the first day also of the Christmas Simbang Gabi, which we celebrate in NDCH as Simbang Tanghali, I went for my Thanksgiving. Strange though, towards the end of the mass, I was sweating profusely even if I was not feeling anything wrong — I wasn’t hungry nor dizzy. Someone noticed this, such that when the final song was over, they wheeled me back to my room.

I spent few more days at the hospital recovering. I was having more well wishers. I again had a 2-D echo to check my LV ejection fraction. It is expected that after bypass procedure, the ejection fraction decreases. Well, as long as it will not be less than 40%, that was what I was told. But what do you know, my ejection fraction from 50% immediately after arrest, went high to 71% few days after the operation. Again, so lucky of me. I really felt so loved by the universe. Dr M Estrada and Dr J Domingo took turns manning my clinic. Dr R Orallo facilitated my insurance claim. Dr C Gomez called for emergency meeting and had fund raising for my sake. The PPS Norther Luzon Chapter and members, as well as colleagues from my locality had been sending financial help. Even younger colleagues from abroad paid a visit. I could not ask for more. After 12 days in the hospital, I finally went home.

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Posted by on January 18, 2013 in Personal

 

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