My event occurred about a little over a year ago ( in 2021). I am 61 years old, without any medical issues, I am thin, I do not take any medication, I did not have high blood pressure and was active and played golf.
On this particular day, I left work from my practice (I am an Orthopedic Surgeon) and I walked home like every Tuesday, since I usually get home in 20-25 minutes on foot, I left around 8:00 p.m., it was a winter day, and I was going fast and with a tight scarf around my neck to protect me from the cold.
About 200 meters from my house, my daughter called me on the mobile, but just at that moment I felt a pain like strangulation in my neck, which initially I thought was due to the scarf around my neck that was squeezing me a lot, but when I let go, it did not disappear. I told my daughter that something strange was happening to me and I quickly hung up on her.
While having pain and a slight feeling of dizziness, I leaned against the street wall, to see if it would stop, but on the contrary, an unbearable pain began and intensify in both jaws, which lasted several minutes. Being alone in the street a few meters from home and the pain subsided a little, I decided to walk to my home, where I sat on the sofa waiting for everything that was about to happen.
When it seemed that I was feeling better, my wife (a Nurse) arrived. I told her that it had probably been an arrhythmia and seemed ok but at her insistence I took my pulse and to my surprise, I didn’t have one! My blood pressure was at a maximum of 6. We called a cardiologist friend and he told us to call the emergency room urgently, it didn’t seem like much to me, so we took our car and headed to the nearest hospital (Hospital Clinic of Barcelona).
Once in the hospital, I underwent routine ECG, analytical and x-ray tests, highlighting only an increase in D-Dimer (During intense COVID times, may people presented it due to the virus), thanks to a 3rd-year Neurology Resident (Dr. Valle Perez) who confirmed the lack of a pulse in my left upper extremity, I underwent prior prophylaxis with corticosteroids and antihistamines (I am allergic to iodinated contrast), a eventually had a CT scan with contrast.
When the CT was finished, I saw behind the glass about 8 doctors, and none of them were smiling, so I imagined that something serious was happening. Before I could go to the stretcher, one of them approached me and told me the bad news. I had an acute dissection of the aortic arch that affected the common trunk, the two subclavian arteries and the two carotids and I had to undergo emergency surgery and the surgeon would talk to me right away.
Dr. Eduard Quintana, a cardiac surgeon on duty, spoke to me that day, and the person who had to operate on me was kind and explained everything very well, but at that moment, the truth was that my mind was somewhere else. I knew that the probability of reaching the hospital alive was 50% and chances of getting out alive and without consequences from surgery, even less.
I signed the informed consent without reading it, contrary to what I require of my patients.
From that moment I didn’t think about myself anymore. I knew that if I died I had lived a good life and I hadn’t left anything to do. I knew I would die anesthetized and without any pain. My grown children had great jobs and their lives were on track and my wife, she would be financially sound.
My priority then was to request my mobile and be able to say goodbye. My first call was to my son who lives in Paris and I sent him a farewell message. I then talked to my daughter to tell her where my Will and important documents were as well as my computer, and bank passwords. I also spoke with my wife. Later, via WhatsApp messaging, I said goodbye to all those important people throughout my life and gave explanations to those who expected to see me the next day. Now it 2am on 3.24.21 and I was going into the operating room.
Before going to sleep I talked to the anesthesiologist as we had mutual acquaintances and she gave me confidence, she told me that I was in good hands with and experienced surgeon.
The surgery (Stanford Type A/DeBakey 1 dissection), replacement of the descending aorta and complete arch, reconstruction of individual supra-aortic trunks, Thoraflex stent implantation 30mmx34mmx10cm in the thoracic and proximal descending aorta, the surgery lasted 10 hours with extracorporeal and hypothermia and several transfusions were required. I woke up in the ICU and I remember little of that day. My first memories were of my son saying, “Hi it’s me, it’s me Victor I came from Paris”, and second a doctor telling me to move my hands and feet. Next, I remember the doctor being happy for me because I could move my extremities without limitation.
I don’t remember anything else, the next thing is that they transferred me to the floor in a monitored room in less than 24 hours, where a physiotherapist came and made me walk a couple of corridors with a walker and everything seemed to go smoothly.
At 48 hours they transferred me to a room on a normal floor and I carried out the transfer on foot, but soon every time I wanted to stand up, I collapsed with sudden paleness and low blood pressure. Initially it seemed that it was my fault or so they told me (fear/apprehension) until an ultrasound was performed showing constrictive pericarditis due to hematoma, so emergency surgery was performed again to place a drain.
At this point, and due to my lack of experience as a patient, the fact that my wife and children could not visit due to COVID made things difficult. I found myself very alone without help and started to do everything without asking, getting scolded by the nursing staff for not doing what they told me to do (not because I didn’t want to, but because I didn’t even remember) there were continuous instructions or demands that made me feel overwhelmed.
Likewise, in the postoperative period of the second operation, in the semi-critical unit, I began with arrhythmias (atrial fibrillation and flutter) that subsided with medication.
Once back on the floor, I realized that I was unable to open a bottle with my right hand, showing paresis of the first \space and lack of strength in the gripper between the first and second fingers of the left hand, as well as a lack of opening (abduction and right hand finger adduction) at that moment I felt a significant fear oaf not being able to return to my activity as a surgeon.
Being bedridden for so many days, and the two surgeries caused me significant constipation and caused an anal fissure. In the end, this was the cause of more pain and disability because nobody cared about that, only the aortic dissection.
The following months were spent trying to rehabilitate my right hand. Not being able to walk or stand because of the anal fissure was unbearably painful and I needed Valiun, Nolotil, Paracetamol and Tramadol at the same time. It took me 4 months to be able to walk and not have anal pain or require medication.
In these four months with rehabilitation and home care I was able to regain normal mobility and strength to my right hand. Regarding the aortic dissection, once I was able to start walking, I recovered well and was able to return to my work and sports activities (Gold) 6 months later.
Regarding my current state, I still have questions that neither my doctors nor my surgeon have been able to answer, since they do not know the origin of these, nor how to treat or cure them:
1. Cyclically, regardless of being at rest or in activity, stressed or not, a severe disabling pain appears once a month or twice a week, which can be in the right arm, in the left arm, in the right chest, in the left chest or in the cervical region and shoulders, individually in each area or at the same time. It can last several minutes and which subsides spontaneously in stretched rest, with tests complementary (BP, pulse, ECG) normal, and at the end leaves a certain headache.
2. I have a very high persistent D-dimer
3. After eating and eating more copious food for a longer time, I need to rest before doing any activity, since I feel very heavy or physically tired in order to get going immediately
Currently in treatment with ASA 100 mg daily and in an attempt, to avoid these episodic pains and maintain low blood pressure, 120mg daily of diltiazem.
I am happy to be alive, grateful to my cardiac surgeon Eduard Quintana and his team, and reintegrated into my previous life despite my current and new “family” who continue to fear that something might happen to me.
Dr. Eduard Siles Fuentes (Barcelona, Spain)
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