The eighteenth day of surgery

The day started with I am having to 'fast' since late last night and leaving home without even a mug of tea. I need to get a blood and urine test done and later show it to Dr. Daud. I have been doing this rather religiously every early of the month, since my bariatric gastric by-pass surgery in early July.

I find this is very important because the drastic weight loss process that I went through is rather a little to taxing for my system. There has been evidence of lack of minerals and of course, personally I'd like the doctor to keep track of how that would affect my kidney and liver function and of course, glucose level.

However, when I arrived at the blood lab, there were already thirty one people ahead of me. So I had to wait. In the middle of that, Abah was brought down to x-ray again and 'Rehab' afterwards. So I left my 'position' in the queue, to be with him. Just when physiotherapy about to begin, word from upstairs said the Tan Sri Mr. Yahya was on his way to the wards. So we abandoned physiotherapy and wheeled him back to the wards.

At before noon Tan Sri Mr. Yahya appeared. He asked to check the chest wound and find it still oozing, although it was much lesser compared to yesterday. He was not to happy with that but after we interacted with him on the problem, he said he would just let the ooze out and dry on its own.

I explained to him that the past two nights, when the sun sets, Abah became restless. Yesterday was particularly terrible. Not only Abah was exhausted when he came up from 'Rehab' (which never happened before), he started to have chest and back pains in the early part of the evening.

The eminent cardiothoracic surgeon said not to worry about that. The more important task at hand is to see that no more oozing and the chest wound is all dried up, like the 90% of it. Going into another invasive procedure to address the problem has not be considered, at this point of time. He also explained that more antibiotics was deployed to take care of the wound.

He also said that he would want Abah to leave and regain the normalcy of his life, at the comfort and pace from his own home. He realised that Abah's uneasiness and restlessness, being infirmed this long, has almost gone to its limit. Patience is a virtue that everyone must possess, in these trying times. However, it is very much easier said than done.

Later, my cousin Nasser Ismail and family came over for a surprised visit. He has been in town for IDRA official business. Nasser drove up to KL the night before my father's surgery, to show support. I have been updating him with progress periodically and he is one of those who follow Abah's progress from this blog.

Today wasn't a particularly good day to me. I spent a lot of time from queueing for my blood test and eventually rather late in consultation with Dr. Daud. So I missed my obesity surgery survivors support group meeting orgainsed by DSH. Later at 3.00 pm, when I wanted to pay for the three hundred RM odd bill for the day, the clerk insisted that I settle a RM 26.00 bill first (which I forgot to pay when I had a B12 vitamin jab the day my father went for surgery), instead of paying the bill together, in one credit card charge. That unnecessary argument cost me 25 minutes!

I simply refuse to barge on a very rigid administrative and accounting policy and system, which is not customer friendly. This is a hospital, not a bank. Patient care and hospitality should be utmost prominence, not petty receivables and cash management rigid system!

I am already stressed out with so many things and issues like this is really not helping. Later I went to my tailor, only to find that he had not made any alterations to any of the eight trousers I sent him since two months ago, which include the two suit trousers. I need them as I was supposed to attend an opening ceremony of a national level convention in Putrajaya on Monday morning.

Tonight, Aishah spent her fifth night straight in a row, on 'duty'. Though she is only eleven, she is getting more alert on Abah's needs and predicament. I and missus felt very sorry that her school holidays was not so for fun for her and instead, had to bear a huge responsibility. For that, I am very proud of her!

More visitation and workout

The day started with Abah's twice daily physiotherapy workout at the 'Rehab'. Then another good immediate neighbour, Deputy Speaker Dewan Rakyat YB Dato' Lim Si Cheng came over to see how he was doing. He was busy these past few weeks with Parliamentary sitting and on weekends, he will be back at the 'kawasan'.
Left: Abah and Dato' Lim catching up
They talked about politics in general and communal issues, specifically. Abah was the resident's association president for a few years and Dato' Lim has been a strong supporter of our activities, even though in his ultra busy schedule. After this visit, he shoot off straight to Segamat and Muo, where the Prime Minister is making a working visit today.

Then another 'zippers' veteran, Hj. Zainal Long dropped by. A course, more tips and comparison of notes and experiences. Hj. Zainal had his CABG in IJN seven years ago. I am particularly touched by the number of 'zippers' veteran buddies who have dropped in, to show support and encouragement on Abah.
Right: Tan Sri Mr. Yahya's visit for the day
In the middle of that visit, cardiothoracic surgeon Tan Sri Mr. Yahya did his rounds. He is happy with the progress and targeting Monday for Abah's discharge, provided the chest wound is all dried up by then.

By then, it was lunch time and I was despatched to buy some rojak at his favourite stall for the past 20 years or so; from Taman Bahagia, SS 2, Petaling Jaya. I brought the two girls with me and they enjoyed the experience of rojak preparation and having cendol by the roadside.

In the late afternoon, another Muo childhood buddy Hj. Tajuddin Nasir and wife Hjh. Umi, came to visit. Abah had just came back from physiotherapy workout and he was unusually tired. So had his rest immediately and was not able to entertain Hj. Tajuddin. So, like always, I had to play host.

Hj. Tajuddin is first cousin to Tan Sri Mr. Yahya. He is no stranger to me. I have known him all my life and I still remember tagging along Abah and him, when I was hardly three. When I was eleven, I had my first round of golf with both of them. Of course, I was Abah's caddy that day at KGNS. I was a good and memorable experience. Being a High School Muo sportsman, Hj. Tajuddin is an excellent golfer.

Then another neighbour, former Chief Secretary to the Health Ministry Dato' Mohamed Zam and Datin also dropped in. Of course, he had more to say as policy for a national heart centre aka IJN for the benefit of growing number of cardiac patients, young and old was incepted and operationalised during his tenure in office.

Slightly later, Dr. Daud did his second rounds of the day. He was on his way to install a pacemaker into a patient when he reviewed Abah, when he complained of tiredness and pain.

Left: Dr. Daud listening in on the breathing and heart

After dinner, Abah had specifically asked Aishah to stay for the night again.

More achievements on physiotherapy

My father started his 16th day of CABG surgery with the physiotherapy at the 'Rehab'. Right after he concluded the morning workout session, two of his kariah members joined him for breakfast at the cafe. As usual, Hj. Aris and Hj. Khalil gave more support and encouragement and ask him to be more patient in this trying times.
Left: At the cafe with Abah and friends. This one of a rare photo of me in these series on Abah's CABG episode





As soon as he went up to the wards, Tan Sri Mr. Yahya and Dato' Dr. Kathiresan did a joint visit, as his wound was still oozing. So Tan Sri Mr. Yahya insisted that Abah keep the 'binder' on and also ordered another antibiotics to be added into his medication.
Right: Tan Sri Mr. Yahya and Dato Dr. Kathiresan helping him up during the ward visit.



Later, I took the girls downstairs for some wifi-ing, at the cafe. I pity them, having to endure all these. They have grown bored with all the toys they have, so cyber games is the only way.
Left: Alia and Aishah, with their ice-blended chocolate smoothies.Note the blog on the notebook screen

They also love the omelette there at the cafe.




Late afternoon, Abah did another session of workout with the physiotherapist at the 'Rehab'. It was more encouraging achievements, as he is able to do the "six minute up and down the stairs" and "six minute on the threadmill" and the pulse did not shoot up above 120rpm.
Right: The six minute second threadmill workout for the day and Aishah trying out the cross trainer





Left: Dr. Daud unbuckling the 'binder' to check on the chest wound
Dr. Daud Sulaiman came for a visit just after six, on his way to another case. He reviewed the chest wound and concurred with Tan Sri Mr. Yahya's earlier instructions. My father implied his impatience on the his recovery process with some mild insinuation. I guess he was just plainly 'restless'.


Later, Dato' Junid Yusof and Datin Safiyah came again for his third visit. He gave a lot of support and encouragement for Abah to patiently continue treatment until all the wounds are clean and the surgeon is happy with his progress for a discharge and continue recuperation at home. Dato' Junid also impressed upon him of further challenges he had to endured, based on his experience. Of course, more dos and don'ts.
Right: Dato' Junid giving more encouragement and support




Just before eight, Abah called the SRNs to specifically get in touch with Tan Sri Mr. Yahya. He was feeling worried about the slight pain in the topmost part of the chest wound.
Right: Tan Sri Mr. Yahya reviewing the chest wound with a led torchlight
So Tan Sri Mr. Yahya came over at nine thrity and explained that the slight pain is part of the healing process and he should not worry. He is anticipating that there would be less if not no more oozes by tomorrow. He also explained to me in private that Abah's sternum is "unsually thin and brittle", which made the process of the chest wound healing much slower and complicated.

Abah determined to regain his normalcy and started physiotherapy, again

The day started with cardiothoracic surgeon Tan Sri Mr. Yahya Awang doing his ward rounds. He reviewed my father's case and allowed him to start the physiotherapy in the Rehabilitation, after it was suspended due to the bleeding last Tuesday's evening and readmission to CICU, which lead to the surgery to correct the switchers on the sternum, few days ago.
Left: Tan Sri Mr. Yahya just about to listen to his chest. Note the 'binder' he was wearing
The physiotherapy would just be exercises involving the leg and he should not be doing any extensive hand movements nor lift anything. He insist that Abah still wear the 'binder', so that the sternum does not move about.
Right: Abah listening to some tips from Zulkarnain
During the ward visit, a childhood friend from Muo Zulkarnain Hassan dropped in to show support, for the third time. Zulkarnain was also a 'zippers' veteran, having to do his CABG at KL General Hospital some 18 years ago. Some people may remember him as a sports commentator in RTM, with a distinctive voice.

After a Curry Mee lunch, at 3.00pm, he was taken down to 'Rehab' for a supervised workout by trained physiotherapists. He started with being asked to move up and down (till eye level) an exercise stick. That is for allowing movement on the shoulder and arm muscles, so that they be stiff, after few days of readmission in CICU and another surgery.
Left: The first itinerary on the workout list. Note; a rare shot of me in the upper left hand corner of the photo




Right: Abah doing his six minute walk. Note, Mak is catching a shut-eye while waiting
Then it was the bicycle again. After that, he was made to walk across the exercise floor, for six minutes non stop. He achieved that. Actually, that is the minimum level of fitness before a CABG patient is allowed to be discharged from the hospital.





Then he did the second achievement for the day, since his CABG surgery on 21 November 2007. He walked up and down the 'Rehab' staircase, twice end-to-end. That was a very encouraging feat, since 48 hours ago this time, he was still under the breathing machine in CICU, recovering from a second open chest surgery.
Left: Abah doing the steps, another achievement since 21 Nov






After all that exercise, physiotherapist Hazimatul Akmal will still check on his pulse rate and blood pressure, which were within desirable and acceptable range for a recovering CABG patient. She was very careful to make sure that his vital statistics are recorded after each exercise activity.
Right: Checks on vital statistics after each activity




After maghrib, Dr. Daud showed up for his rounds. He gave some tips and dos and don'ts, in anticipation of Abah's expected discharge from the hospital this Friday. The questions he asked, it clearly show how eager he wants his life to be normal again.
Left: Dr. Daud patiently explain to an old man the adjustments that he got to make

Abah is out from CICU and starting to walk, again

This morning my system partly surrendered. After 17 days under all sorts of stress, my back simply refused to co-operate. So I arrived at the hospital a little after nine forty five.

Tan Sri Mr. Yahya Awang already reviewed Abah's case and he is allowed to be discharged from the CICU. Most probably, by evening time, he should be walking around the room, to regain his fitness level and also maintain blood circulation.
Left: Being wheeled out of the CICU for the third time in 17 days
So at 11.00 am, the CICU SRNs moved him out, along the longish corridor on the fourth floor ward towards the east most end of the floor.

Mean while, at the ranch, the two girls who are permanent features of suite 421, are doing their best to kill their boredom and get on each other's throats. So they started to play all sorts of things and games, especially the interests on the new Barbie set have faded away.
Right: Trying their best to hide from Papa/Pak Long!
The suite is so far end of the building that the wifi signal is irreliable and not stable. So I decided to take them downstairs to the cafe, so that the can do 'their thingy'.


I asked the missus to go and do her thing while my parents take their afternoon rest. I actually have lost count how many days she actually missed work, even though she had classes to do and attend.
Left: A peck on Mama/Mak Long's cheeks, before their trip to the cafe
So there we were, at the cafe. We were seated next to Tan Sri Mr. Yahya Awang, who was enjoying his tuna sandwich lunch (there was no other table near a power socket).

After I logged on to the Streamyx, I invited Tan Sri Mr. Yahya to briefly browse my blog. I explained to him that I have kept a daily log online, to document the experiences that we had to endure, since Abah was infirmed in IJN 24 days ago, for the planned angioplasty, which was aborted. He said it was alright for me to share this experience and as long as this is not construed as 'advertising his services', online.

I also explained that I wanted to accord and document their good work, in giving someone like my father a 'new lease of life', which is rarely understood by the average populi.
Right: The girls so engrossed on their portals
Soon enough, the girls were on their favourite portal, playing games against each other. That actually took three bloody hours!





When we went up after a couple of round of snacks, Dr. Daud was about to do his round. This is his first interaction with his cardiologists, since the second surgery and not under the influence large dosage of sedatives and pain killers.
Left: Dr. Daud illustrating on the procedure which was necessary




My mother's close personal friends also called on her and of course, my father. Since Abah was infirmed in the DSH Heart Centre ward, she has not left the ward.
Right: Mak's closest friends around the neighbourhood called on the both of them

At circa 6.00pm, Abah went to do for his 'walkabout' around the ward. From the looks of it, he is so determined to 'regain' his life back, especially after some 'setback' to the recovery process that was doing rather progressively well; at least the early part of last week.
Left: His first walks since the second surgery
So Aishah, my brother Najib and his daughter, Balqis, walked him to the nurses station and back. He did the circuit, twice.

Second surgery successful

We were at DSH as early as 6.00am. My brother picked my aunty up at Sri Damansara, on his way from Gombak.
Left: Leaving for the OT, first thing in the morning
The SRNs collected Abah from his suite at 7.30am and wheeled straight into the OT, for Tan Sri Mr. Yahya Awang to correct the switchers that held the both sides of the sternum. It was sawn apart for the coronary arterial by-pass graft surgery (CABG) on 21 November but because of 'violent coughing', the switcher in the middle was dislodged.


By 10.15am, he was wheeled back into CICU after a successful surgery. Tan Sri Mr. Yahya Awang explained that all was fine. Dato' Dr. V. Kathiresan wanted him to rest without any pain, so he was given sedative and put under the breathing machine. He promised to review the case again by 2.00pm and allow my father to breathe on his own, without the machine from 3.00pm onwards.
Right: The CICU staff busy receiving Abah straight from the Cardiac OT


Aishah went to see him at 1.26pm and he was aware of the surrounding. So when Aishah held his hand, he gripped back, almost trying to find comfort.
Left: A girl trying to comfort her grandfather
Moments later Tan Sri Mr. Yahya Awang came to review his patient's case. He saw that Abah was in a little discomfort. So he called up Dato' Dr. Kathiresan and painkillers were ordered for him, in preparation to take him of the breathing machine and breathe on his own.



He would be allowed to have some sips of water, an hour after the that.
Right: Tan Sri Mr. Yahya making his rounds
Tan Sri Mr. Yahya assured us that he would make Abah's recovery post this second open chest surgery more comfortable.








Tan Sri Mr. Yahya showed me the x-ray of the switchers in placed, after the surgery. I think more were added.
Left: Aishah looking at the x-rays, six day apart, before and after









As again, Abah has an incurable headache and nausea, due to the doses of morphine given to him for the chest wounds. So the remedy that we can offer him is mentholated ointment or minyak angin.
Right: A traditional remedy for headache; minyak angin and TLC



By dinner time, we was spoon fed by Mak with some porridge and some steamed salmon and haruan. He had an encouraging portion, for someone who had his chest opened, twice, within 12 days. He also asked for some freshly squeezed orange juice; to get rid of the nausea feeling.
Left: Dinner, just after maghrib
He looked he like was comfortable. As we were leaving the ward for home, just before 10.00pm, he asked for this morning's paper. I guess, he was plainly bored.

The day before second surgery

Today is Abah's fourteenth day being infirmed in Damansara Specialists Hospital.

Tan Sri Mr. Yahya Awang came to check on his patient at 9.30pm. Although there was still oozing, he was generally satisfied. A new consent was obtained for the surgery, scheduled tomorrow morning at 7.00am.

Left: Dr. Daud illustrating the formation of the stenum, post surgery
Later Dr. Daud came to check on Abah. We basically interracted with him and his explanation was as convincing as Tan Sri Mr. Yahya's, yesterday. The formation of the sternum was crucial for him to heal well. Hence, the decision cut open again and correct the situation.

In the middle of the interactive consultation, my cousin Datuk Dr. Mahmood A Kadir and wife Datin Teh Zaiton brought his mother Habsah Abdul Ghani, my father's only surviving elder sister to visit. Her worries is clearly visible on the 77 year old woman. Datuk Dr. Mahmood also had a little time to interact with Dr. Daud on my father's case.
Right: Datuk Dr. Mahmood listening closely on Dr. Daud's explanation




Left: The worry of an elder sister
Datuk Dr. Mahmood said ever since she learnt about Abah's heart by-pass surgery, she has been worried and sometime, that pushed her bloodpressure up. So they decided to bring her over to see her only surviving brother for herself and diminished some of her worries.




In the middle of that, cardiothoracic anaesthethist Dato' Dr. V. Kathiresan appeared to check on Abah. He also obtained another consent for the surgery, first thing tomorrow morning. As usual, Dato Dr. Kathiresan said nothing should be out of the ordinary and everything would be fine.
Right: Dato' Dr. Kathiresan sought another consent





Later in the late afternoon, his childhood buddy Hj. Mohd. Farid and wife, Hjh. Maznah popped by. Its been fourteen days since we last saw them. although they have came over to the house to hand over some snake-head fishes (haruan), to be cooked for my father.
Left: Hj. Farid showing support for a friend of over 50 years




In the evening, our immediate neighbours, former MITI Deputy Secretary General Dato' Kalsom Abdul Rahman and former MARDI researcher Dr. Mohamed Senawi, came to visit. They came separately but coincidentally arrived together. Both shown termendous support for Abah's courage and patience to weather through these trying times.
Right: Neighbours in the show of compassion and care


After Isya' and dinner, two Mujahiddeen mosque kariah members, Hj. Shamsiri and Hj. Mohd. Nahar dropped in, to see how someone in the neighbourhood was doing. They offered a lot kind words; solace for Abah. The want him to see the silver lining through this rough weather. Hj. Shamsiri dissected a verse from the Quran to explain why God test His servants and there is a solution or opportunity, in every misdeeds. He even was kind enough to offer prayer, for Abah's surgery tomorrow.
Left: Hj. Shamshiri led a short but meaningful prayer

To family and friends who have offered prayers in my father's moments of trials, I would like to express my utmost sincere appreciation and gratitude, for these very thoughtful deeds. My Allah s.w.t., God al Mighty, the Merciful repay the goodness and kindness of your heart, where ever you may be.

Amin.