Cardio Logic (English)

‘I keep you here and that cycle test we don't need any more,’ the cardiologist said.

A story about a positive week in hospital.

The events are real. I gave most people other names, but that did not affect their characters at all...

1 Cycle test

‘You will stay here and you don’t have to do that cycle test any more,’ the cardiologist said.

‘You’re kidding!’ This was a bit a surprise to me. ‘No getting my toothbrush from home?’

‘Better not, sir. I am going to take you in right now, if it can be scheduled you will have your cardiac catheterisation today and then, as soon as possible, we ‘ll perform an angioplasty or another operation.’ He seemed very determined, so I quit further struggling.

‘How did you get here?’ I think he already knew...

‘By bike,’ I said, and it sounded like I had gone through red traffic lights several times.

‘Did you feel pain in your chest, or in your arm?’

I confirmed. ‘Yes. In both arms.’

He examined the ECG once again. I had it made with with a nurse at the opposite side of the corridor. The appointment itself had been made by my family doctor, who also had made such an ECG, but had assured me: ‘At rest it doesn't show anything wrong, but to be sure I’ll send you to the cardiologist as well. That had happened ten days ago. In the meantime I felt pain during excercises, for example cycling or hiking. Especially when it was cold outside. I didn’t know that this was typical for angina pectoris.

Now I had been cycling to the hospital, and had been instantly forbidden even to walk! Anyway it is strange if a medical specialist is more frightened than you are as a patient. With the right form in my hand, I was handed over to a nurse, who put me in a wheelchair and pushed me to Coronary Care. The way I was transported, with my raincoat and hat on my lap, it felt like I had been caught in the act.

During the first hours, every few minutes somebody appeared to check me. I got a telemetry box with me, more to put my guards at ease than me. The box transmitted eight different data to a monitor in a control room. I imagined that such a room was alike one in a nuclear power plant. Any other kind of power plant had been better this time...

My worst concern at the moment was, how to pee. I couldn’t succeed on my back. Sitting upright also was not a good idea, because all curtains were open and from all sides neighbours were watching me. I don’t like disaster tourists.

‘We have permission to bring you to the Cardiology Department,’ announced male nurse Pieter. The first results of the blood samples were good enough for promotion. Again I was moved, now in a bed, by two nurses. My coat and hat on top. The telemetry now was reduced to four signals. Even these four seemed a bit overdone to me, but it was clear I had lost most of my freedom of speech.

The box stayed present till after the catheterization. After all, I proved to be right then, without seeking it. Before that moment my guards in the control room had exiting minutes. One of them was sent up to see whether I had died or had a flat battery. With a new Duracell I met all requirements again.

In the meantime it became clear that catheterization on the same day did not fit in the schedule. I was put on the list of next Monday. Ada was assigned to bring more clothes. She was on a hike with her Nordic walking club when I had left for my appointment at the hospital and wondered why I was not at home when she returned. Shortly after that someone from the hospital had called her and explained the situation.

Until the angioplasty, so for one week, I was happy I couldn’t cycle. A visit to the toilet, brushing my teeth, even washing became quite a job. After such an effort I enjoyed my bed. So this bed was often in the relax-position. In this position one has a perfect view on the rituals in the room. In the beginning, one really has to get familiar with all. But after a few days I found myself quite involved in the daily procedures.

Initially, I was surprised by the expertise of my room mates. ‘Nurse, don’t you have to flush my drip needle?’ ‘Sorry, you are right!’

I firmly decided not to bother myself with anything. I didn’t even want to know about my medicines. I just should swallow whatever they offered me, without asking questions. Maybe one of the reasons of my disease could be: feeling responsible for too many and too much...?

2 Room for humor

I immediately became friends with Ome (uncle) Joop. 

He made a joke of everything and good-heartedly teased everyone, including staff and patients. Ome Joop knew how to make jokes about you without creating distance by doing so.

‘Au!’ he shouted every time, just before the needle touched his arm. Every new nurse rose to the bait. ‘But I haven’t even injected!’

‘No, but it’s just not to forget!’

Like me, Ome Joop waited for a heart catheterisation and a plan for treatment, which would be made immediately. We both had about the same attitude. ‘You can worry, but something has to be done anyway. So let those specialist do their work, worry will not help at all.’

My bed was on the left, by the door. Ome Joop lived opposite to me. Next to me, at the window, was Van Lunteren. Van Lunteren was in a bad condition. He had got a number of by-passes, but before they took him to the hospital, he had fallen on the back of his head. Later on it became clear that also a coagulum had done some harm in his brain, so he was not be able to follow any more. Just before the operation he seemed to have intercepted only ‘Goodbye’ from the cardiologist, who actually said: ‘We will make you a set of good by-passes!’ This was not helping his state of mind too much either...

Van Lunteren had been a farmer his whole life. He was used to have a lot of room around. Some people say that you shake off all unnecessary ballast. Van Lunteren surely had done so. When dinner arrived, we all took place behind our rolling table, facing the window. So did Van Lunteren, sitting on his bed. Then, as a firm ritual, he closed his eyes, lifted his butts, put pressure on it and and farted loudly.

The first time he took me by surprise, the second time I silly held a newspaper up. Later on I just left the lid on the plate till the air was clear again. Now I know what these lids are for.

The first night in a hospital I hardly sleep. This time was no exception. Van Lunteren suffered mucus production and he constantly tried to get rid of it. The loudness of his attempts made us raise in our beds. If he could reach his Tupperware box, the harvest was brought in there. In the morning, the nurse went searching for that box. That could be anywhere and anything could have happened to it. When it was empty, she was wise enough not to look further.

Also Van Lunteren had a bad first night. Just after one he woke up, completely lost of course. I heard him work in his bed. He was not allowed to leave the bed, and leaving the room for water works was out of the question. ‘Garretje.... Garretje.....!’ He stumbled out of his bed. ‘Garretje!’

A natural ‘Farmer-seeks-wife’ case, it occurred to me. Van Lunteren headed for Van Barneveld in the bed on the right side and pulled the man’s arm. But his neighbour had got enough sleeping pills not to react. In the near-dark now Van Lunteren fully undressed, and headed north, towards my bed, saying: ‘Save me from the sins...save me from this sin...’

This was enough for me to ring the bell for nurse Helena to come...

The next morning, everyone had forgotten what happened.

It should be worth a scientific research on it. Were old men undergoing healthcare more obedient than women? From the moment two really old ladies joined us, they kept the nurses rather busy. They didn’t ask, they demanded. Maybe they had been the boss of the household during whole their life? Maybe the men had let that happen and were well adapted to that situation?

Beppe (granny) Zijda was a 91 years old Frisian lady, with a clear accent pointing at the East of Fryslân. Like all my room mates, she wore hearing aids. Without them she did not hear a word, at least she pretended so. Also, Beppe Zijda refused to take any pills without her artificial teeth in. However, this often did not fit in the schedule of the nurses.

‘I must have my teeth. My tééth...!’

‘But why can’t you take those medicines without your teeth?’

‘No, you have to give me my teeth.’

The nurse gave in, because any other solution would take much more time. Then Beppe chewed her pills, drunk some water and called the nurse again.

‘My teeth. They have to be brushed again...!’

‘But I did brush them ten minutes ago, don’t you remember?’

‘It has to be done again, because you ordered me to eat the pills.’

Mrs. Van Straaten on the right side was made of the same stuff. She collected too much liquid and was on short rations with respect to liquid food and drinks.

‘I would like a cup of coffe and a glass of orange juice, nurse!’

‘You’re not allowed to have so much. It is not good for your legs...!’

‘Then give me the juice now, I’ll take that coffee later...’

The nurse put her support stockings on. After less than an hour Mrs. Van Straaten called her. 

‘I want those stockings off! They itch and I have to get rid of them!’

‘But the doctor prescribes it, you know that! Against the liquid!’

‘Get them off! This is unbearable. And I want some water as well.’

During the day, both ladies used to sit some hours in a chair, well brushed up and shining. Fully equipped with hearing aids, artificial teeth and wig, the walker within reach. They never looked out of the window, but were always facing us, the men. Mrs. Van Straaten did not show any emotions, but Beppe Zijda was always looking at us with interest and satisfaction, looking at two men, not doing anything in particular as well.

Ome Joop usually reacted first. ‘Hey, what are you doing? Trying to seduce us? Better mind your heart! Take care, your temperature will raise too much, if you don’t mind!’

As soon as staff entered the room, they were involved in the joking activities as well. They knew very well, that their pills trolly wasn’t the only medicin for a quick recovery. So we never called them ‘pills’ but ‘candy’, ‘party drugs’ or just ‘The sweet comes in...!’, without further explanation of what exactly we meant...

Ome Joop often used to comment on the fact that my visitors often were female, apart from Ada of course. Many of them indeed have paid a visit to me, and a few sometimes not. 

‘Let me advise you as a wise and older man, so many women around you isn’t good for your heart,’ he said after the visiting hours, with a poker face.

‘I think you are just jealous!’

‘Well, at least I can keep an eye on you here.’

‘There is a Donald Duck to keep you busy...’

We had the inclination to turn everything into something funny or at least positive, whoever was within our reach. We have had a lot of fun, about all the superfluousness outside and the core issues inside. I am convinced of the profit, for the nurses too.

3 Blind Spot

‘Do you know who I am?’ He stood big, black and intimidating at the foot of the bed.

‘Y-yes,’ Van Lunteren stammered.

‘Well, then tell me...!'

Van Lunteren had no answer. For him the man had the appearance of Death himself, or at least one of his deputies. 

He had sailed into the room, rather after the visiting hour at noon, because that is always what they do. We all were tired and after lunch we were happy to take some rest after the effort of eating and the medicines round. 

Also Van Lunteren was tired. He had some visitors and had struggeled himself under the blankets, fully dressed and sub-titling his movements. 

Last days we had seen him making some progress. The first day he had been laying in his bed, almost delirious, and hardly approachable. Now, a few days later, he obviously recovered and even reacted on our jokes. 

‘Hey, Van Lunteren, where are you taking that nurse?’

‘W-washing,’ he had answered humorously, ‘and y-you are supposed to stay here...!’

When he returned, he wore his best trousers and a nice shirt, holding nurse Zwanette’s arm.

‘Look here!’ Ome Joop commented. ‘With what lady do you have a date? Or is our Queen visiting you today?’

The whole morning he had been sitting in his chair, proudly upright. From time to time his tall body took off a bit, followed by a well-known noise. Then Ome Joop and I smelled his contribution before the air-conditioning on our side could grab it. A few times he took part in our conversations and it made sense. We were satisfied and proud. Joined efforts of relatives, staff and our jokes had brought Van Lunteren where he was now.

He hardly had a few minutes of sleep, when the man came in. He wore a stiff, not well-cut black suit, his meaty and reddish face sticking out. His big hands, how could they pass through those sleeves? I wondered. Shiny black shoes were on his feet in stead of wooden shoes. We were too polite to refuse his visit. And I still doubt whether he would have left if we had asked him to do so...

With long breaks, he asked questions. It was obvious that he did not feel at ease. As if he had some doubts about the success of his mission. 

‘How are you doing, Van Lunteren?’

‘G-good... but not sleep well... wake up well, I think... saved a lot... had a good sleep, bad sleep after all...’

‘So you feel better after the first days?’

‘N-no... but I... saved and slept and saved again woke up bad...’

This obviously was not the man we had been talking to today. Van Lunteren was completely confused and off the track. Maybe he wanted to say something else, but access to the right words seemed to be failing.

The deacon turned to us ‘I expected to see a man in a better condition...?’ he complained. ‘I was told that he had recovered yet!’

Black turned back to Van Lunteren. ‘You do read your Bible, don’t you?

Van Lunteren scared. ‘N-no.’ Of course not, he could not read, even if he should want.

‘But you know you should, don’t you, Van Lunteren? I hope you do believe that the LORD can save you...?’

‘S-save... yes. Save and sleep... sleep well, not good, awakened I think...’

Again it was silent for a while. Van Lunteren fell asleep. I didn’t like this at all.

‘Van Lunteren, do you already know why I am here?’ God knows what kind of punishment the poor man would become if he couldn’t come up with the right answer now.

‘I think... think...save....maybe the whole night, yes.’

‘Do you expect to recover?’

‘I... I hope.... yes!’ Bravo Van Lunteren.

The deacon bent over the bed. ‘But you also know that the chances are that you will die, don’t you?!’

‘Maybe... save....good sleep...’

I started to be angry. Ome Joop pretended to be asleep. This had to finish, the sooner the better. This visit had nothing to do with helping someone, but only frightening. After fifteen years experience with counseling adults with serious religious doubts, never ever I would take someone’s believe from him, but there are limits. This black warrior was nearing these limits. So, it still exists, I thought. And they sincerely believe that it is right what they’re doing. Well, I was convinced that it was contrary to all efforts of all those dear professionals who gave everything in order to put Van Lunteren on his feet again.

Finally the visiter started a prayer for (or against?) the old man, with a strange voice that sounded at least one octave higher.

Van Lunteren said ‘Amen...’ and that seemed to satisfy the deacon.

‘I wish you the best, Van Lunteren! And remember, recovering is not the most important thing of life!’

Van Lunteren did not answer. The right side of his vision was damaged. It had become his blind spot and the deacon disappeared in it. I waited for two minutes and heart that Van Lunteren had fallen into a sound sleep.

That night I felt again pain in my chest and the nurses were busy with ECG’s and spray under the tongue. The deacon had taken in not only Van Lunteren...

4 Are you sure?

It’s in the flyer of the hospital. 

Many things have happened in the last period. You have been treated in the hospital because of a heart disease. Such a heart failure is a radical event. Heart problems can give fear and uncertainty. Your faith in your own body can be decreased.

I am glad I only have a heart disease and not something more serious. During those weeks before the operation I had had some troubles. Especially during riding my bike. A red traffic light was my friend. It could not last long enough. However, cycling back was not always painful. Maybe there was nothing wrong with my heart?

When I was hospitalized, and I unexpectedly had to stay there, the cardiologist preferred the nurse pushing me to cardiology in a wheelchair. But wasn’t I able to judge what I could do or not? Til then I had perfectly been able to decide when time had come to stop for a moment, in order to continue after some rest. The pain had never gone worse. So, I refused to consider my heart as unreliable from now on.

On my rolling desk was the book of Anna Drijver I was reading: Je Blijft. Only the title was enough to make it a good book.

The heart catheterisation made things clear.

‘Look, here it is,’ said the performing artist on my side. He pointed at the screen. We watched the film once more, after the operation.

‘You have got a set of strong left dominant coronary artery.’

Okay, I had learned something. Dominant, I was aware of that. I also regard myself as a left person, but the combination was quite new for me.

The fat artery was blocked for 90 percent, but even then the opening left was big enough to disconnect the permanent telemetry. However, the remaining gap was too little to dismiss also the urgency.

‘Was it better or worse than you expected?’ nurse Helena wanted to know. She came and sat with me for a moment. I found it hard to think in terms of expectations. I preferred to react on the facts.

By all means, I was glad about the catheterisation via the pulse, through the radial artery. I could start drinking my compulsory amount of water to thin the contrast liquids now sitting upright and from time to time walk to the toilet. This was much better than laying flat on my back for hours because of a plug in the groin.

‘I am happy to know the problem and a clear solution,’ I answered. ‘The heart has been protesting for some time, but has always kept working properly, even when I wanted it to do more than it could do.’

‘No further damage?’

‘According to the doctor not. Isn’t that great? This gives a lot of confidence, isn’t it?’

She looked at me quizzically. ‘It is a way to look at it, but are you serious, or are you putting on a brave front?’

‘No, I am serious. I might doubt of my heart, and feel as if it has abandoned me. But in fact I feel the opposite, I abandoned my heart more than it did to me. In spite of too less energy supply, it continued working and still stayed undamaged!’

‘Yes, that is another way of perception, but you might be right! It is a good attitude for the future, I think.’

An ambulance took me to the Rijnstate hospital in Arnhem for the real angioplasty. Now the catheter was brought in via the femoral artery in the groin. During the operation we had a vivid conversation about the quality of the stents. The size - 9mm diameter was quite a size, but necessary.

‘No problem, you will enough room in there in case another operation will be necessary.’ I had no such plans, but it was good to keep it in mind as a positive point.

‘You know,’ the cardiologist said, ‘half of 9 mm left in a blockage, is quite more than half of 6 mm.’ After some thinking he added: ‘Actually one third more.’

‘Twice as much, because it’s the surface area, so squared,’ I suggested, a little bit too bright for the situation.

After the treatment, back in Ede, I had had my obligatory flat-lay time and I felt good. No complications in the groin. Nurse Helena found that they had given me a ridiculously large bandage in Arnhem. Tomorrow I should face the removal from the hairs. Maybe I could not, but that was no problem now. I was happy not to suffer any pain, after-bleeding or other problem. After all, everyone had assured me that those ‘cables’ were easily accessible, so I thankfully added also this to the list of positive results. Maybe these professional ‘stabbers’ liked it, working in such an inviting drainage system.

Also the blood laboratory samples showed good values and that meant: going home on the day after!

At home, my first thing to do was to cancel a few pieces of work I had agreed on to to. The circumstances... I am not depressed or in trouble, I am realistic and optimistic about the future, but at the same time I do not want to jeopardize this. I don’t like to meet the man with his hammer again.

Nurse Marjanne is expecting me for an intake session for the normal re-validation program. Although I do not feel devaluated at all, but learning about parts of the program will do no harm either. And who knows someone can profit from my experiences as well.

So we’ll see what to do. To be honest, I don’t think I will sit there on the floor, legs open, with ‘Fetch the ball, here it comes...!’

5 From Arnhem with tears

‘I am very sorry, but you must know I am such a hyper-active one...’ she said. She was sitting on her bed. I could not see her well.

‘I am not allowed to raise my head,’ I said. ‘If you can come over to me, we can talk easier. And by the way, you could fill up my cup-of-water again, if you like.’

She came and stood by my head.

‘Hi. I am Moniek. And I am a nervous wreck... But You noticed that before, I am sure. And I think I am not ugly, what do you think?’

Moniek was already there when they rolled me in after the angioplasty. She looked about forty years old, and anything but skinny. She faced a heart catheterisation, but was still not sure about the results and the following treatment. Her husband and a lady friend had taken had accompanied her. The doctor could convince them not to stay here but to go home. The moment she was scheduled was not known yet and visitors were prohibited in these waiting rooms.

In the meantime I had been operated according to plan and busy with my first can of liquid. Fully flattend out, because of a plug in my groin.

Indeed she was not ugly at all, but my first impression was also: moving. In the first five minutes after her husband had left, she had already confessed half of her life, had a crying fit and made herself a bit presentable again.

‘They say I should calm down myself more, but how do I do such?’She looked at me. ‘Do you know how I do that?’

‘I think I know how to do that myself, but maybe that doesn’t work for you...?’

‘Okay, never mind. Just tell me what they did to you now. How is it done? Was it very painful? You know, I am frightened to death it will hurt...’

To me it had not been painful at all, except for the moment the little balloon had blocked the corony artery completely and I had felt the pain of a real heart attack. But that situation I did not mention in my report. The doctor should tell her what she would feel when the moment had to come, alnd also that it would move over in a minute.

Her cellphone rang.

Hubby asked about her condition and reported that he had a fried egg for lunch.

She immediately jumped on it.

‘Did you clean the pan? And the cooker? And please use the vacuum cleaner, because you probably made a mess of it...!’

‘I know, I know,’ she said when she came back to my bed, hopping from one leg to the other. ‘I know I should not meddle in, but that’s me...’

‘So..?’

‘So that is probalbly why I suffer a heart disease...’

I slowly turned my head towards her and saw her worries.

‘And of course I eat too much. Look.’ She grabbed a surplus of under arm between thumb and forefinger. ‘But maybe you are right. In about an hour I have had the worst and am I allowed to go home...’

Soon the nurses came and took her away. I was still waiting for the ambulance to bring me back to Ede.

After half an hour I had drunk all the prescribed liquid and was allowed to sit upright on the bed. After a few exercises I could walk to the toilet without pain or other problems. Hurray!

I just was visiting the toilet again when I heard the ambulance male nurses arriving and asking for me. When I slipped into the room for the last time, Moniek was just brought in.

‘Hello,’ she said feebly. ‘Are you still here?’ Immediately she started crying. ‘I have to suffer an open heart operation, and now I feel completely lost!’ she sobbed. ‘Please come to my head a moment, so that I can see you...’

She was very sad, but she did not keep it inside... Good for her...

‘Look at me...’she went on gasping. ‘I know you not yet half an hour! But I’m so happy to see you for a moment!’

The ambulance drivers just let us for one minute. They were busy, but they decided that there should be time for a hug.

The whole day, Moniek was in my head. And maybe also a bit in my heart as well...

6 Being ill = becoming better

‘I just drop by to say goodbye,’ she said and took a seat at my bed. Nurse Helena had ended her night shift and I was expected to go home after some hours. Funny, she only had had night shifts, and I had not been a problem at all, so she had not have to worry about me too much. Yet I felt a kind of special relation with her. Perhaps the contact in the night is more intimate? In the semi-darkness of the night everything happens in the oval of a torch. Conversations are held at a level of whisper, in order not to wake up others. In the dark, things seem closer.

After a few days I recognized the footstep of the permanent staff, and when they were too far away, also their voices. In the dark, the silhouette of Helena was unmistakable, with the thick head of hair bound in a pigtail.

‘You had a lot of fun here, we noticed.’

‘That’s because so many funny things happen here!’I answered. ‘Seriously. As a matter of fact, there is not only a lot of fun here. I saw many good and positive things happen here.’

‘Well, we do not hear this often,’ she said. ‘I’d like you to tell me some more in detail...?’

So we spoke about the filtering properties of a hospital environment. In the first place for patients. All superfluous ballast is stripped off at the moment of hospitalization. Status, wealth, important business relations, even a number of unnecessary worries, you can leave them outside the walls. You take only your health and how you feel with you. The contacts with the staff and often with your room mates as well, are about your health. You have to deal with whoever is with you living in the room, whatever you are in the outside society. You are healthy reduced to the essentials: your body and your character. All in all, in this mini-society only the essentials matter.

‘Hmm, you must have some sensibility to discover this,’ Helena said. ‘But I think you are right. For us people are not all the same, but we try to provide them with what helps them best, even if it does not fit in our scheduled work.’

It was a good moment to tell her about my admiring for her and other nurses, when they stayed kind and polite to Beppe Zijda, when she had called them the forth time in an hour for a sanitary attempt without producing one drip.

She laughed. ‘That’s not without self-interest,’ she answered my hidden question. ‘You know, going home half an hour late, leaving happy patients behind, I feel much better than returning in time with bad feelings about the result.’

The same I had heart ‘food’ nurse Corrie saying, after she had brought one of the old ladies a cup of soja milk she had warmed for them in the pantry, beyond the scheduled tasks.

As if it was quite normal, Helena concluded: ‘After all, it’s best to do according your character. If you don’t, you eventually will run out of energy...’

They all were like her, as far as I noticed. Anna, with Harry in her wake, Janneke, Kim, all of them were toppers. I was lucky to have them caring for me.

At the same time it became clear to me that ‘market’ rules and healthcare never could develop a healthy relation. Care and carefulness cannot be measured in euros.

The outside world come in by mail and visitors. Also this meant: re-validation, focusing and filtering. Ada was my connection to the world and managed everything. Good (most lady) friends paid a visit once and some of them sometimes not. No conversation was idle. Not one talk was about this, that and the other. Children and grandchildren, they helped me recover. Mails and postcards communicated: wait a moment, we’ll find you. They all made clear that the world of the hospital is not an isolated one, but only a healthy shield inside the world.

My body is working properly again. The narrowing in the coronary artery has been my alibi for widening my insights. So, from the bottom of my heart I can say: thank you all.