Personal Stories: Ramon Pierson

About 3:30 on the afternoon of 3rd December, 2004. My wife and I were walking along the shore near our home in West Sussex. The tide was in so we’d been trudging through deep shelves of flint shingle high on the beach. It was strenuous going, but on previous occasions I’d kept up a good pace through the shingle in spurts to ‘get the circulation going’, as it were.

Suddenly I felt a burning in my throat and down into my stomach. At first I put this down to heartburn from the exertion after a full lunch, but it was worse than any I’d experienced before. I told my wife I’d have to hurry home to my stash of antacid tablets. She was content to hang back and continue clipping twigs from bushes to force into leaf in a vase.

My fast walk quickly turned to a headlong lunge. I’ve since roughly measured the way home. Just over 600 meters, but that day it seemed like as many miles. The burning grew more intense and then began a ripping pain in the middle of my back that spread out both sides. Breathing became more difficult and I was only able to sip air and let it out in spasms. Some part of my brain was working. By this time I’d discounted dyspepsia and I wondered if I was having a heart attack, but I was experiencing none of the signs I’d heard about. At last I reached home and headed for my Rennies (antacid tabs).

When my wife arrived shortly after, I was crouched at the edge of the bed and clinging to the radiator which was rattling to my spasmodic breathing. She called the emergency services who said an ambulance would be along soon and I was to lean back and breathe steady. This was hard to do but it gave me something to concentrate on.

The paramedics found me slipped down on one knee and wedged in between bed and radiator. When they couldn’t get a wheelchair around close enough, I tried to stand but couldn’t. Neither could I roll across the bed. My legs wouldn’t work. In the end they had to lift me across the bed and set me in the wheelchair. They hooked me up to oxygen and we went off in the ambulance. Breathing was a bit easier and I could speak more than single rasped words, enough to give the paramedics some idea of what I felt. Strange was the loss of the use of my legs. I could feel them but not move them. As we drove, the paramedic continued to stroke a pencil over the soles of my feet, but there was no reaction.

In the A&E I was breathing better and the sense of panic diminished. I was x-rayed and questioned about what had happened by several doctors who were puzzled by my inability to move my legs. Even after movement slowly came back, they returned with questions, and with shift change a couple of hours later another lot started. They called me ‘the enigma’. When, by about 9 p.m., it looked like I’d be kept in over night, my wife left for home.

Not long after, I was told that the x-ray showed that my aorta looked a bit enlarged and I was taken for a CT scan, which revealed an aortic dissection. The doctor said this might be treated with blood pressure medication, less likely that surgery would be required. A while later another doctor stopped by to ask me how much effort they should put into resuscitation. This seemed a bit extreme, but I played along. I told him, well, it’s my life, so give it a good shot.

Just before I was moved to the cardiac ward I was shown the CT film and saw the dissection for myself. I was just getting settled in for the night, when I was told I’d soon be transferred for surgery to either Southampton or Brighton, whichever had a slot. In the meantime they had to get my blood pressure down to 100. In the small hours of the Saturday morning I was bundled into an ambulance and trundled off to Brighton about 35 miles away with a young doctor in attendance and an automatic blood pressure check every 15 minutes. In the meantime my wife had been alerted and was heading the same way in a taxi.

On arrival in Brighton my wife and I were told that my condition was life threatening. I needed immediate surgery and the surgeon had been woken up and was hurrying from home. They described the operation (they’d pack me in ice to slow my heart rate, stop my heart, patch the aorta with dacron and then restart my heart) and the risks (not surviving surgery, kidney failure, the chance that I’d lose the use of my legs, plus a few more dire possibilities). None of this sounded great, but without surgery I could expect to live about ten days. Tops. I signed the consent form and was quickly prepped and wheeled off to the operating room.

I woke up several hours later in a morphine fog to see my daughter and my wife floating near my bed. My daughter had driven down from London very early that morning when she heard what was on. They stayed that night in the hotel that the hospital had set up for such purposes and when they came back the next day I was slightly more clear headed.

Two days later, Tuesday, I was moved from ICU. I could walk about and a physical therapist ran me through some simple exercises. On ward rounds Thursday doctors said I could go home next day if an echocardiogram showed that my aortic valve was OK and if I could pass their stairs test. That meant walking down one floor and back up again. I cleared both tests and late Friday afternoon, a week after the dissection, my daughter was driving me home.

Recovery over the next couple of weeks was flat. We started with the advised 10-minute walks twice a day (more of a shuffle at first) and gradually increased time and distance. The first week in January I had a bout of shingles, which set me back a bit. On hearing about the dissection, the substitute GP who diagnosed the shingles kept looking at me in an odd way that suggested she’d never seen a live one. I figured she’d love to take me on an exhibition tour.

By the time of my six-week checkup I’d got past the shingles and soon afterwards the recovery curve eased northwards. Walks gradually increased to a mile round trip to the shops. On Valentine’s Day I started driving again, though daily walks continued, and around Easter we took our first longer walk into the hills (with several stops for a breather on the way) to see a field of wild daffodils and primroses. In mid-April we managed a steeper hill where there were broad expanses of bluebells, and as summer progressed we were walking everywhere we used to go. Since June ‘05, after my six-month checkup, I’ve been doing aerobic and strengthening exercises twice-weekly in the Phase IV cardiac rehab scheme set up for those with heart attacks, shunts and bypasses. I’ve never met another who has had a dissection. On the anniversary of the dissection repair I had my latest visit with my cardiologist, who had checked my August CT scan, echocardiogram and all the rest, and declared me fi t. Next visit in a year.

So I’m a long way from where I was 18 months ago. Physically. Even so, I still experience phases where my energy suddenly flags, and I’m frequently cold, perhaps due to the beta-blockers and blood thinning tablets. The Phase IV sessions have restored a good measure of lost confidence.

Mentally it’s another story. The 10-inch zip in my chest is like a watershed mark. Partly as a joke early on, my wife and I took to referring to the time before surgery as BZ (before zipper) and since then as AZ. At first I wasn’t sure that the dacron graft wouldn’t blow any time I sneezed or coughed. The thought of being a few miles from home was daunting, so trips we’d planned were cancelled or put on hold. Short-term memory has been a concern. I heard it might be from being so long on the heart-lung machine. It could also be from inattention; since the dissection I know I don’t focus as well: things don’t matter quite so much. Or it could just come with being over 65, or letting my mind go fat and flaccid since retirement.

The biggest thing to get my head round is how close I came to not being here. It was luck that the ambulance was nearby. I was lucky, too, that the doctors in A&E kept worrying me with questions until they knew what was wrong and didn’t just send me off with a handful of antacid tablets after a superficial examination. About every day I think of how close the edge of the world is and how easy it can be suddenly to step off.

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