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The operation! By Ciaran

With Charlotte's memory being a bit shaky and then she was unconscious here's my version of events (Ciaran, Charlotte's boyfriend)

My day started a little different than usual as I had planned to go into work a little later due to having anticipating I'd be staying back, so I was up at 9am, ran for a shower, got dressed, woke charlotte up in the process as usual and then gave her a squeeze and a kiss on the cheek before leaving at 9:30.
Something valuable I've learned from the situation is that I should've pulled over on my drive to work to answer Charlotte's call as at 9:45am my phone was ringing in the car. Assuming it could wait I arrived at work for 10:00am sat down at my desk, remembered charlotte had called and rang her straight back, to which she answered with "they have a heart for me". I immediately picked my bag up and told work I had to go.

I sat in my car and it hit me, I was shaking and according to my fitbit my HR had risen from my rough 58bpm average straight to 92bpm, I had a little cry, composed myself and drove over to Wythenshawe and managed to beat Charlotte to the hospital where I carried her suitcase to the ward and we were just sat anticipating what would happen next.

Charlotte seemed very relaxed considering the situation and told me to write in my notes what was happening so I recorded the fact that we were sat on a male ward due to it being the only available bed, her blood pressure was taken, then an ECG and blood tests and lastly charlotte was given a gown and taken for an x-ray. During the 5 hours we were waiting at this point the anaesthetist and surgeon came to visit Charlotte where she had to sign papers (Charlotte doesn't remember this) to agree to the procedure and everyone from the hospital that was involved in the journey asked the question "do you know what operation you'll be having done today?' which was a strange repetition but was obviously needed in the circumstances. Whilst on the ward Charlotte was really calm but she did whisper to me that she was scared.

At around 3:55pm Charlotte was given two tablets for anti-rejection before then being sedated and I was luckily able to be with her during this as she squeezed my finger which was more for my comfort just to see that she was going to be ok, during this as the anaesthetist was about to put the Propofol into Charlotte the Co-ordinator whom was in the room received a call at which the anaesthetist asked "are we still going ahead?" and the coordinator replied "yes, carry on" as she'd just had an update on the donor heart. Around 2 hours later the Transplant coordinator came round to see myself and Charlotte's mum to explain that things were going to plan and Charlottes heart was out but they were still waiting on the Donor's heart to arrive at the hospital, which was a little unnerving at this sensitive time to say the least and she also sent me the pictures of Charlottes heart there and then through email at Charlottes request. I didn't look and kept them private until Charlotte was able to see for herself.

We received an update at 7:50pm explaining the new heart had been put in and was beating however the operation wasn't finished as they need to keep an eye out for any issues such as bleeds. Then about 11pm they said they were finished but Charlotte wouldn't be out for another couple of hours whilst they just sat and watched her in theatre and seeing how she coped, whilst also adding all the extra drips and medication. Then finally at 12:30am the nurse said we could go and see her!

Myself and Charlottes mum went in first due to the '2 at a time' rule on the Cardio Thoracic Critical Care Unit (CTCCU). As we went in to the room I was expecting Charlotte to be by herself, however was surprised to see that this was an open unit where many patients remained once out of surgery. As I approached her I was overwhelmed by all the equipment that was keeping Charlotte going and all of the noises, particularly the balloon pump which was making her jerk and it looked to me as if she was struggling. The nurse started to explain what everything was doing and for the first time in my life i could feel myself start to faint, I lost my vision and hearing but somehow managed to walk back to the waiting area and sit down before I fell. I managed to go back in to see her one last time to say goodnight before I drove home.

So the rest of the journey is a bit of a blur to me too I'm not going to lie but here are some of the things I remember.
Charlotte at first had two large drip stands consisting of:
Propofol: The main sedative
Alfentanil: For pain relief and also sedation
Dopamine: To help the heart function
Adrenaline & Noradrenaline
Sodium Chloride
Added to this she was on a Ventilator, Feeding tube, Pacing monitor, Balloon Pump.

The next day we noticed a dialysis machine had been added which the doctor explained to us was to help with her fluid rather than the kidney function. Throughout the first 48 hours they informed us she was doing 'okay' and things that were happening were not unusual considering the severity of the operation. They explained they wouldn't be bringing her round for at least another 24 hours. The main issues we were told about were that they had issues with her nitrate levels and also blood pressure.

After about 4 days Charlottes consultant visited her whilst myself and her Dad were beside her bed, he explained a couple things to us from the previous days, It had been mentioned her right side of the heart was struggling which is why they were in no rush to wake her up. The consultant then explained this to us that he wouldn't word it as 'struggling' as it appeared to be dilated but this was improving and they had seen it in previous restrictive patients for unknown reasons, possibly chest cavity. He also described the first 48 hours as "a bit on a knife edge" but was really impressed in her progression since. It was explained the balloon pump was in but only on half power as he was convinced it wasn't needed but whilst charlottes blood platelets were low it was no harm staying in due to risks of removal. All medications had been reduced in terms of either volume or concentration at this point and organs such as the liver were described as "rock solid". He also expressed Charlottes strong will as whilst being sedated he was performing an Chest x-ray and she tried sitting up and opening her eyes. We'd had a couple signs of this due to some comforting hand squeezes but she wasn't ready just yet.

Roughly a week had passed and they said they were looking at waking her up after several good nights. They began to do this at around 7pm one evening and Charlotte started to wake up very fast once the sedation was off. With her ventilator tube still in her mouth she was limited to responses with nodding and shaking of her head. The surgeon who visited regularly came over and despite being tube tolerant the surgeon recommended sedating her again slightly so that they could remove the tube more safely in the day time with more staff on site and people to assist as this is a dangerous task in itself.

Thankfully Charlotte doesn't remember this happening or the balloon pump being taken out which is for the best because I can't imagine it was very nice!

From Charlotte

So I was asleep for just under a week and then when they woke me up I was sedated because I was really uncomfortable and that's when I started hallucinating and I thought I was dead! So my memory of that time is completely different to what actually happened!

What has been lovely at the hospital is that you don't have to be related to be treated as family, so if your best friend is your support network then that's who they allow in. They ask you all these questions in your initial meetings, so they knew I wanted Ciaran in ICU and my parents, but they also let Emily (dad's gf) come and see me and I think my grandparents and my friend Nat. So they limit the number of people originally because the more people you're in contact with the higher chance you'll pick up an infection, and that includes when you're out of ICU its 2 in 2 out but once you're on the ward visiting is any time which is really nice.

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