Back in 2006, when I was still in my 2nd year of medical school, my dad had an episode of NSTEMI (heart attack) and he was hospitalized in PPUM for a week. There, he was also diagnosed with 8cm
abdominal aortic aneurysm (aka triple A). Doctors tried to convince him that it was very very dangerous and he needs operation ASAP but my dad, being the hard-headed person, refused any treatment and defaulted all follow ups. I, being the daughter, and also a medical personnel, knows the urgency and the catastrophic event that can result from his illness and I have been "bugging" him to get something done but he continued to refuse treatment.
One bad thing about triple A is that there is absolutely no pain and symptoms. Patient would feel absolutely nothing and comfortable regardless the size. My dad thought that he was ok and actually believed that the aneurysm can actually shrink within time. I have no idea where he got that concept, no from me absolutely.
Picture showing aneurysm. My dad's aneurysm was 10 cm. Yes, you read it right...TEN blardy CM!After a few years of nagging, my dad eventually succumbed to it. He finally agrees to go for a check up last month. It just so happens that currently I am in a vascular unit in surgical department, and I called up one of the consultant surgeon and referred my dad to him.
My dad went for a check up in his clinic straight away he ordered my dad to be admitted the very next day for further investigations and pre-op assessment. He was in ward 14 (surgical ward HKL) for a few days and CT scans, lung function test, ECHO, etc were done. Everything looks prefect and he seemed fine to undergo a major surgery. His aneurysm has expanded 2 cm since the last time he checked and currently at 10cm. According to my consultants, my dad is a rare case which at 10cm, his aneurysm hasn't actually leaked or ruptured.
Mr Naresh (the consultant surgeon), talked to my dad and the rest of the family about the urgency of his operation and what would happened if he does not go for surgery. I myself saw the CT scan and i was shocked (and I cried) when I saw how thin his aortic wall was. It was super thin that i believe it can rupture just about anytime.
The surgeons then referred my dad to Hospital Serdang for further evaluation of his heart since he has a history of IHD. The cardiologists did an angiogram for him there. Initially they wanted to do angioplasty for him but when they saw the angiogram, they told me that he needs a bypass (
CABG) and can't perform any angioplasty for him since he has 3 vessel disease and his LAD is already 90% blocked. At that point, I was praying so hard that my dad won't have to do an open surgery because I know his heart could not take the stress during the operation since they need to clamp the aorta if they go for open surgery to repair the aneurysm.
After much discussions among the specialists and surgeons from HKL, Hospital Serdang, and IJN, they have decided that they have to do the aneurysm repair (
EVAR) first since it is semi-emergency and CABG post EVAR. Bare in mind that it was a super major surgery. The complications during operation includes MI, aneurysm rupture, conversion from EVAR to open surgery (which my dad can't take it),
DVT, acute limb ischaemia,, and stroke.
My sister came back from the USA to give my dad and the rest of the family moral support. The operation really hit my family hard. All of us including my extended family were worried sick, we cried, and we all really did pray hard for him.
On 27th of October, they went in to the OT. The surgeons cleared up the whole day and concentrated on my dad's case alone. There was no other OT that was on. Mr Zainal, the head of department, happens to know the pioneer of EVAR and he called him up to scrub in together with the team. In a way, that gave a boost of confidence and a relieve for us..not that we didn't trust our own surgeons (they are the best in Malaysia...all aneurysm cases from this country will be referred to the vascular team in HKL) but it was kind of a comfort to know that the pioneer himself was there.
The operation went smoothly at first. They started at 9.30am and finished at 12pm. I was informed by the OT staff nurse that my dad is well and will be transferred to ICU shortly. I was waiting outside of the OT with my mom and sisters and after half an hour, still no one came out from the OT and no sign of my dad.
The staff nurse came out again and told me the news I dreaded for. There was a complication. The surgeons are opening him up again and doing emergency embolectomy since they couldn't find any pulse over his lower limb and on table angiogram showed there was a block over his popliteal vein. I stood there for a minute, stunned. I went back out and break the bad news to the whole family. We went back to his room in ward 14 to wait and started to recite prayers and yassin for his well being.
From 12 noon until 4.30pm I was walking back and forth from OT to ward 14 to OT just to check if they have finished with my dad's operation. I waited in front of patient's waiting bay since I was not allowed in. I only got a few updates from Faizal, the houseman who scrubbed in (unofficially my eyes and ears in OT that day).
At about 4.45pm, my dad was wheeled out and transferred to GICU. After they have attached all the equipments and machines onto my dad and anaest doctors did the post-op review, we were allowed to go in. He was on ventimask by that time and already extubated. My sister woke my dad up by telling him the time but he was still drowsy from all the anaesthetic given.
Diagram showing the simplified version of EVAR that was done for my father. He was in GICU for a day and transferred to general ward (MY WARD!) for close monitoring (but not as close as in GICU).
It was awkward and a bit weird for me and my colleages to have my dad around as our patient, especially in acute cubicle. By the time he was in general ward, he was already being himself. The talkative, whiny, and funny self.
On the 3rd day post-op, he was transferred back to his room ward 14 as he does not need close monitoring anymore but just 4-6 hour monitoring of his vitals.
On Friday, 4 days after his major operation, the team decided that he is strong and well enough to go home. Mr Naresh briefed me about what to expect once my dad goes home and what he should and shouldnt do, which includes no golfing for 2 months.
As of today, it has been exactly a week and my father has been doing extremely well, Alhamdulillah. He is already up and about, tolerating orally well, fever just settled, and complaining every second that he wants to go for putting and golfing. It was another miracle that he recovered this quick. I guess because of his pre-morbid condition prior to the operation was good
(NYHA Class I with EF of 51%..!!) helped the short recovery period.
Whatever it is, I'm so glad to have my dad back and relieved to know that he will be there for my wedding day and to be my
wali for my akad next year, insyaAllah.
For those of you who prayed, called, texted, visited, on behalf of my family, THANK YOU very very much. God bless.
**My dad told me when my sister Farah woke him up after his operation to tell him that it was already 5pm, in his head he was thinking "Crap! 5 more holes to go!" - he was playing golf during the whole operation! Morphine and Fentanyl can really do wonders.
***I'm sorry cause there's so many medical jargons. It's difficult for me to explain every single thing but I've tried to make it easier to understand by linking some of the words to the Wikipedia page...sorry..=)
