Archive for April, 2020

The “Spanish Flu” Pandemic

April 18, 2020

Sp flu ward 2The worst pandemic to hit the United States before COVID-19 was the “Spanish” influenza epidemic that followed the end of World War I.  The parallels between that epidemic of one hundred years ago and today are striking, and show both how American society has advanced and regressed.

Though commonly called Spanish Flu, was first widely known among the troops in Europe, and was called ‘trench fever.’  Though wartime censorship makes it hard to track, it may have been endemic to German troops on the eastern front in late 1917; in the spring of 1918 they postponed a western offensive until influenza subsided in 3rd week of March. The Kaiser himself fell ill with the flu in July, 1918. It evidently took the name “Spanish” flu because Spain was neutral in the war and had no press censorship, so the first mentions of the severity of the illness came from Spanish newspapers.

Sp Flu liberty bonds

Modern studies attempting to track the spread of the virus think that it may have arrived in America via Chinese workers being sent to work on the war front in France; a “serious outbreak of pneumonia” was noted in Shantung province, on the Mongolian border in December 1917, and pandemic influenza struck Shanghai in May 1918.

An army cook at Camp Funston, Kansas is considered to have been the first U.S. influenza victim, dying in March 1918. In April 1918 the USS North Carolina docked at Norfolk, reporting 100 mild cases of the influenza.

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Communicable diseases were not uncommon in one hundred years ago. Many were deadly, and most were debilitating. Before the flu arrived in the fall, there had been more than 2200 deaths in NC in 1918 from typhoid fever and tuberculosis.  Older forms of influenza were seldom deadly- called “the Grippe,” it was most dangerous to the weak and elderly. North Carolina created a State Board of Health in 1877 but the first local health department was established by Guilford County in 1911.

A bulletin from the U.S. Public Health Service (The Courier, Asheboro, 10-10-18, Page1) noted that-

“Epidemics of influenza have visited this country since 1647. It is interesting to know that this first epidemic was brought here from Valencia, Spain. Since that time there have been numerous epidemics of the disease.  In 1889 and 1890 an epidemic of influenza, starting somewhere in the Orient, spread first to Russia, and thence over practically the entire civilized world. Three years later there was another flare-up of the disease. Both times the epidemic spread widely over the United States.”

sp flu wardThe difference with the influenza of 1917/18 (now called the Influenza A Strain) was that it triggered a virulent reaction in the immune system of those who were strongest- those twenty to forty years old, young and fit; in many cases it killed in less than 48 hours from first fever to last breath.  As its victims’ lungs filled with fluid and their respiratory systems failed, their skin, starved for oxygen, turned blue- giving the tabloid headline name the “Blue Death” to the new influenza.

The virus came in 3 waves, the first breaking out from October 1918 to Feb 1919 and eventually spreading to every corner of the earth. A second wave occurred in the summer of 1919, and the third wave in 1920 claimed another 100 thousand. As many as 40 million people may have died and half the world’s population was infected.  No vaccine was ever created, and even today no treatment would be available for this type of flu.

In April 1919 Dr. William Rankin, secretary of the State Board of Health, reported that more than a third of the state’s 2.5 million citizens had been infected, and 13,644  had died, including 17 doctors- 13 times the number of Tar Heels killed by the Germans in WWI.

The influenza first appeared in North Carolina in Wilmington on September 19th, 1918, and within a week it had overwhelmed that city’s hospital, considered one of the state’s best.  The contagion spread West from Wilmington into the heart of the state along the railroad lines, ravaging military camps across the state.

Flu dangerous as poison gas

On October 3, 1918- Governor Thomas Bickett issued statement from the Board of Health on dangers of sharing eating and drinking utensils, unrestrained sneezing or coughing; he issued an order recommending curtailing social functions and public gatherings, and proposing quarantine for those infected- they were prohibited from leaving home without a doctor’s note

Although we are missing many issues of the local newspaper for the years 1917 and 1918, the first mention of the flu from the Asheboro Courier is found on October 10, 1918, just three weeks after it was first noted in Wilmington. “Spanish influenza is rapidly spreading in this county, and the schools have all closed, as well as all other public gatherings. We think that the prohibition of the Greensboro fair was right and proper.” (Courier, 10/10/18, pg4).

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Surgeon General Blue

A interview with Surgeon General Rupert Blue (called “Uncle Sam’s Advice on the Flu”) published a week later noted- “In contrast to the outbreaks of ordinary coughs and colds, which usually occur in the cold months, epidemics of influenza may occur at any season of the year, thus the present epidemic raged most intensely in Europe in May, June and July….

“In most cases a person taken sick with influenza feels sick rather suddenly. He feels weak, has pains in the eyes, ears, head on back, and may be sore all over. Many patients feel dizzy, some vomit.  Most of the patients complain of feeling chilly, and with this comes a fever in which the temperature rises to 100 to 104. In most cases the pulse remains relatively slow.

Sp flu stop spitting“In appearance one is struck by the fact that the patient looks sick. His eyes and the inner side of his eyelids may be slightly “bloodshot” or “congested,” as the doctors say. There may be running from the nose, or there may be some cough. These signs of a cold may not be marked; nevertheless, the patient looks, and feels very sick….

“No matter what particular kind of germ causes the epidemic, it is now believed that influenza is always spread from person to person, the germs bring carried with the air along the very small droplets of mucus, expelled by coughing or sneezing, forceful talking, and the like by one who already has the germs of the disease. They may also be carried about in the air in the form of dust coming from dried mucus, coughing or sneezing, or from careless people who spit on the floor or on the sidewalk.” (The Courier, Asheboro, 17 Oct 1918, p6)

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Rupert Blue

An interesting sidelight is that Surgeon General Rupert Blue was a native of Rockingham, in Richmond County, North Carolina.  Blue (1868-1948) entered the US public health service in 1892, and made a name for himself coordinating the federal response (yes, there was one even back then) to the San Francisco bubonic plague outbreaks of 1900-1904, and again after the earthquake of 1906. He was also involved in efforts to control yellow fever in New Orleans in 1905. He was appointed Surgeon General by President Taft in 1912 and served until March 1920, and oversaw the dramatic expansion of US public health services during WWI. The U.S. Hygenic Laboratory which Blue established created vaccines against tetanus, diphtheria, typhoid and smallpox, and after the war, laid the foundation for the creation of Veterans’ Administration hospitals and clinics. So it is no exaggeration to say that the foundation of our modern health care system was put in place by Surgeon General Blue. [And I might interject, that he is probably some kind of relative of my father’s mother, whose maternal grandfather was Evander McNair Blue of Moore County.]

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Back on the home front, the Randolph County Board of Health took decisive action based on years of knowing what had worked to stem the spread of incurable communicable diseases. Schools were closed. Both live and moving picture theaters were closed.  There were no bars, as prohibition had ended alcohol sales, and there were few restaurants, as most people cooked at home. The Randleman Chrysanthemum Show was cancelled.  Joel Trogdon, minister of Charlotte Methodist Church, announced that the Richland Circuit quarterly conference was cancelled, as well as the associated preaching services. He rescheduled for the next month, “we hope influenza will be subsided by this time, if not perhaps we can hold our meeting out of doors.” (Courier, 24 Oct 1918 p5)

In Asheboro, “The influenza situation in Asheboro has greatly improved over what it was last week. The people have been using precautions and should continue to do so…. Much anxiety is felt in Asheboro and Randolph County for the Randolph boys in France and especially for those in the Thirtieth Division, as they have evidently been in the thick of the fighting during the recent battles. One boy has written that he has been in the trenches sixteen days at a time.” (id)

In Trinity, “Trinity High School has suspended on account of Spanish influenza. Some of the older people say, this is the first time the doors of Trinity has been closed in October for over 70 years. In other words, the school has been in progress here for 70 years, probably a little longer. The doors were not closed during the Civil War.” (id)

And in Franklinville, the war also precluded too much worry about the flu: “The last report of all Spanish influenza cases in the community are on the mend, and it is not expected that any cases will prove fatal…. Our farmers are busy gathering and husking corn, and preparing to sow a large crop of wheat this fall and are doing all they can to help our boys push their way to Berlin.” (id)

Sp Flu ambulance stationBut the same edition of the paper showed that local people were dying.

“Private A.M. Phillips died at Camp Joseph E. Johnson, Jacksonville, Florida, last Tuesday morning at ten o’clock from pneumonia following an attack of influenza. The deceased had been ill about two weeks. The fact that he had suffered from four previous attacks of pneumonia probably made it harder for him to combat the disease. Mrs. Phillips and Miss Kate Phillips were with the husband and brother when the end came. The body is expected today, after which the funeral will follow. Private Phillips went to Camp Hancock, Augusta, Ga, July 26, last, with an increment of Randolph men, and was later transferred to Camp Johnson. He was at home on furlough just a few weeks ago.

The deceased is survived by his parents, Mr. and Mrs L. C. Phillips, Asheboro; one brother, Mr. Hal Phillips. Asheboro: and four sisters, Mrs. Walter Davis, Randleman Route; and Misses Kate, Lizzie and Alice Phillips, Asheboro; besides his wife, who was Miss Erma Lynch, of Asheboro Route 1, and to whom he was married about six mouths aero. A large circle of friends throughout the county sympathize with the bereaved family.”

And-

“Mr. Gurney Davidson died at his home west of town last Thursday from pneumonia following an attack of Spanish influenza. The burial was at West Bend church the following day…  Mrs. Gurney Davidson died in the evening of the same day her husband was buried from the same fatal disease, and was laid to rest at West Bend on Saturday… Mr. Davidson was about 35 years of age… Three small children, the oldest only six years of age, are left orphans by these deaths.”

A week later, the headline was that flu had claimed the President of the University of North Carolina.

Sp Flu Edward_Kidder_GrahamDr. Edward Kidder Graham, eighth president of the University of North Carolina, and a prominent educational figure in the nation, died last Saturday night at his home, Chapel Hill, from pneumonia following an attack of Spanish influenza. Dr. Graham had been ill less than a week, the disease assuming the most malignant type and turning to the dread pneumonia in two or three days. The funeral was held at Chapel Hill, Monday afternoon. There was no service at the church or home, but a simple service at the grave… All work at the University was suspended for the day and the faculty and students attended the funeral in a body. [The Courier, 10-31-18, p7.  Marvin Hendrix Stacy, the chairman of the faculty, became the acting university president after Graham’s death. On 21 January 1919, Stacy also died from influenza. [https://exhibits.lib.unc.edu/exhibits/show/going-viral/unc ]

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On October 31, the State Board of Public Health reported that “Taking the State as a whole, the influenza situation is looking better, the reports showing marked improvement in a number of towns. On the basis of imperfect reports, it is estimated that the number of cases in North Carolina, dating from the first outbreak in Wilmington, will pass a quarter of a million before it runs its course. The death rate in Raleigh so far has been about three per cent of the cases, as estimated, and on such a basis the ravages of the disease will kill 7,600 North Carolinians.”

But the end of the war brought a setback. Social distancing restrictions were loosened following Armistice Day, with unintended complications. By the end of the month, T. Fletcher Bulla, the Secretary of the Board of Health, put even more restrictions were in place.

“On account of the influenza situation and the danger of spreading the disease, the County Board of Health has decided it is inadvisable to hold the regular term of court for the county scheduled to begin December 6th. After a conference with local officials, the members of the local bar, and Judge Long, I am directed to say that the term has been called off. Parties, witnesses and jurors are all hereby notified that they need not come.” [The Courier, 11-28-18, pg5].

“Ramseur has been struck with influenza the past two weeks. Over two hundred cases have been reported, with three fatalities. We hope the worst is behind us now. It seems to be abating but we find this is a very subtle thing, it come unawares and spreads like fire. Let us be as careful as we possibly can lest it takes a heavy toll from us yet.” [The Courier, 12-12-18, pg1].

In January 1919 the Courier reported that it was unable to print the newspaper on schedule.

“INFLUENZA RAGING IN ASHEBORO ATTACKS COURIER FORCE.  During the past few days many people of the town have been stricken with influenza, few homes having every person confined to bed. The disease seems in lighter form than it did during the first epidemic which was visited upon the town during the first of November. The Courier force has been so afflicted, having three members out, that we are unable to appear in usual form. We feel that our readers will understand the unfortunate situation. It is under difficulties that we appear at all. We hope’ next week to make our usual appearance.”[The Courier, Jan. 16, 1919, pg1]. Neither of the paper’s linotype operators, L.B. Lambert and C.L. Scott, had fully recovered by February 6th.

Sp flu nurse masksThe second wave of flu had disappated by May, 1919, but then reappeared full blast in the winter of 1920. “For more than two weeks the epidemic of influenza has been in full blast at Coleridge. Practically everybody in the town has had it, there being more than 250 cases. Up to date only two deaths have occurred, that of Mrs. L. B. Davis, and Mrs. A.M. Poole. Mrs. Davis died the latter part of last week. She was 35 years of age, and a daughter of the late Gurney Cox. At the time of Mrs. Davis’ death her husband was seriously ill with influenza. Mrs. A.M. Poole was a daughter of Mr. W.A. Poole, of Coleridge. She is survived by her husband and three children.” [The Courier, 5 Feb 1920, pg1.]

When the Randolph County Board of Health met in February 1920 “a number of schools, churches and Sunday schools of the county were closed on account of the prevalence of influenza. Among the schools that have closed are: Coleridge, Pleasant Grove, Brower, Richland, Grant, Columbia and Tabernacle townships, also Miller’s school and Wheatmore school in Trinity township and Central Falls school in Franklinville township. It was further ordered that the stores in the county be closed at 7 o’clock p.m. and unnecessary congregating in cafes, barber shops and other public places be prohibited. It was also ordered that all moving picture shows of the county be closed for a period of two weeks. Another order was that all the children in a family where there is a case of influenza be kept out of school for two weeks. The matter of losing other schools in the county and taking further precaution to prevent the spread of influenza was left in the hands of Messrs. W.L. Ward, T.F Bulla and Dr. C. A. Hayworth, who were authorized to take any steps that they deemed wise without consulting the county board of health further.”

In late March, one of Asheboro’s best known citizens died of the flu. “The news of the almost sudden death of Capt. A.E. Burns at his home in Asheboro on Wednesday of last week was a distinct shock to his many friends in Randolph County. Capt. Burns had influenza but was improving and at the time the call came he was sitting up in bed, talking to some friends, assuring them he would be out in a few days…. Mr. Burns was the son of B.B. and Fannie Moss Burns. He was born in Asheboro and has spent his life here, consequently was known by every body- to his old friends he was known as “Eck Burns”… At the age of eighteen years Mr. Burns went in the employ of Southern Railway and came in to Asheboro on the first train as baggage master. Twenty five years ago he was promoted to conductor and has served the railroad in that until his death… “  [The Courier, 25 March 1920, p1]

flu ad 1During the 1920 epidemic, the Fletcher Bulla recommended 9 suggestions for good public health.  Some show that some major improvements have occurred in a century-

“Don’t use public drinking cups that have not been properly sterilized. Every school child should carry an individual cup… while at school.”

Others would be familiar today, human nature having not changed that much-

“Avoid coughing, if you must cough or sneezing, place a handkerchief over your mouth.

“If you go into a room where any patient is confined with … gripe or colds, use a mask or handkerchief over your mouth and nose and wash your hands if you have touched the patient, bedding or other furniture in the room.

“Promiscuous kissing should be avoided.”

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*Final note:  I know of no official statistics for the number of Randolph County citizens who died during the Spanish Flu pandemic. Because of wartime censorship, the figures that might have been available were not published, and because of the lack of testing and treatment facilities, the number was probably much higher than was known at the time.  Some day perhaps, a comprehensive review of death certificates might give us a ball park figure. But the number was shockingly large, even to a generation used to sudden death and incurable disease.

For more information on the 1918 pandemic, see the following excellent sources:

Cockrell, David. 1996. “A Blessing in disguise’: The influenza pandemic of 1918 and North Carolina’s medical and public health communities.” NCHistRev 73 (3) 309-327

Pettit, Dorothy Ann. 1976. “A Cruel Wind: America Experiences Pandemic Influenza, 1918-1920. A Social History. Univ. New Hampshire PhD Diss., 1145.

Plague and the Pest House

April 15, 2020

Pest House patientI am writing this from my home in Franklinville, NC, in the midst of COVID-19 self-isolation. For most of America, home isolation is designed to “flatten the curve”- to impose community isolation measures that slow the spread of infection and keep the daily case load at a manageable level for our existing health care resources.  In my case, it’s to protect me in the wake of my recent heart surgery, and keep me from the risk of pneumonia on top of asthma and post-anesthesia breathing issues.

All this was getting underway as I entered the hospital, and ten days later was in high gear in North Carolina, with public schools and university classes cancelled or forced online; public libraries, museums, historic sites and non-essential businesses closed; restaurants and bars reduced to drive-through and take-out service, if at all; and Americans all over the country urged to practice ‘social distancing’ by not meeting in groups or religious services, wearing masks and gloves, and maintaining a six-foot distance from one another.

Pest House isolation

As I write this, these measures have had some success when adopted early, as in San Francisco, but have failed to stem the tide of infection in cities such as New York and Philadelphia. They seem to be helping in North Carolina, despite vocal opposition from a minority who consider any such restrictions overwrought, bogus, or unconstitutional.

It has been accepted in modern America that the fall of every year brings the onset of ‘flu season,’ and persons susceptible to lung problems are urged to get prophylactic flu shots developed to take the edge off last year’s version of the flu. People die every year from complications of the flu, and, like gunshot victims and automobile accidents, are accepted as part of modern life.

Pest House Dr McCoy

I’m a doctor, not a bricklayer!

The current pandemic, affecting virtually every country on earth, is different because it is NOT last year’s flu, but something new, and the traditional flu meds don’t seem to be working. It is also different because our national ability to respond to this kind of crisis has been nibbled away by lack of funding, or crony capitalism, and simple complacency.  Even though 2019 was the centennial of the worst pandemic in modern history, we came to believe that such things just didn’t happen any more, that modern medicine and modern technology could whip up a vaccine at the same speed Dr. McCoy could cure the malady of the week in one episode of Star Trek. This is not the case as a look at the history just underneath our present day will show.

Pest House Yellow Fever

Yellow Fever in New Orleans

When I first moved to Franklinville I interviewed a lot of people about the history of the community, and one of the first things I learned was that, while life wasn’t exactly cheap, death was always just around the corner. Families were large, but would have been even larger without the regular deaths of young children from incurable diseases such as mumps, measles, whooping cough, and polio.  At any point of the year, ancient adult diseases such as smallpox, yellow fever, typhus, cholera, typhoid fever and tuberculosis might flare up and take friends and family away with little or no warning.

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Death was so common, and so accepted, that there was a rote process for dealing with it. In the weave room of the Lower Mill, I was told, a 3×6-foot wooden tabletop was stored in a rack over the windows- the “Cooling Board,” the community catafalque. When someone died, the cooling board was taken to their house and set up in the largest room, to clean and embalm the body and hold the coffin for the wake. After the funeral, the cooling board was taken back to its rack in the weave room.

Pest House Burlington KY

A mill village, an urbanized community with houses set closer together than in country living, was especially vulnerable to communicable disease. While Franklinville had its own doctor, it had no hospital, and indeed, there was no hospital in all of Randolph County until the 1920s.  What Franklinville did have was its “Pest House,” short for ‘Pestilence House.’

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London Pest-House, St. Giles Cripplegate

As community health-care facilities, ‘Pest Houses’ date back to medieval times. Daniel Defoe in A Journal of the Plague Year, states that in 1165 London “it was a great mistake that such great city as this had but one pest-house.”

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In fact, many if not most North Carolina towns and counties of the early 20th century had their Ppest Houses. A look through contemporary state newspapers of the time shows that Wilmington spent $350 building a frame pest house 50 feet long by 20 feet wide. Charlotte in 1914 built a new one with ten rooms “divided into male and female compartments.”  High Point, Lexington, Concord, Gastonia, Asheville, Alamance County, Durham, Oxford, Raleigh and New Bern all budgeted for the operation of their pest houses, paying cooks, cleaners, wood choppers, and guards for both day and night shifts during peak periods of operation- which at the time were chiefly during smallpox epidemics.

Pest House Lynchburg VA

Lynchburg, Virginia Pest House

So common were the annual outbreaks of small pox that Raleigh in April 1899 voted to change the name of its Pest House to the “Raleigh Small Pox Hospital.” Said the city Superintendent of Health, “The people of Raleigh are now, I believe, ready for compulsory vaccination. It has been shown in other places- Charlotte and Rocky Mount have used it to good effect…. At Charlotte, one man was put in jail for refusing to be vaccinated, and at Rocky Mount, two were sent to the roads.” [i.e., the county jail road maintenance gang].

Pest House lysolMiss Kitty Caviness, a retired teacher, first told me about Franklinville Pest House, which was in the hollow between her house and the Lower Mill. It was a small cabin or “fever shed” with beds, and if the illness was something that could endanger the whole village, the patient was taken there under quarantine.  I never saw the building; as far as anyone could remember, the Franklinville Pest House was last used during the “Spanish Flu” epidemic of 1918-1920.  “It smelled like sulpher,” said Miss Caviness, and undoubtedly this was due to the common practice of the time of disinfecting the air by burning sulpher in open pans in each room.

Pest House wardI’m told that Randleman also had a Pest House, perhaps shared with Worthville, and this may have been a feature of all the Deep River Mill villages.  Universal vaccination for communicable deadly diseases gradually did away with the need to isolate patients from their neighbors, but the sudden rise of the “Spanish Flu” in 1918 brought them back into wide use for a few years- and triggered a movement to build community hospitals in rural areas.

More on this in a separate entry.

Heart Surgery in the Plague Year

April 5, 2020

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There are times when events gang up on us and deliver punches to the gut so that we have no choice but to recognize that ‘this is history’ – we’re experiencing something we will look back on as a turning point, a life-changing event.

The swift and radical upheaval of society triggered in early 2020 by the COVID-19 Coronavirus is certainly one of those time, locking down nursing homes, flooding emergency rooms and ICUs; prematurely ending school years and college careers; closing businesses and squeezing restaurants and bars into drive-throughs, take-outs and food truck equivalents; and forcing families to stay inside at home as if beautiful spring weather was the same as ice-bound snow days.

signboard informing unavailability of sanitizers

Photo by cottonbro on Pexels.com

The pressure for this started in China at the end of 2019, and built up gradually in January and February 2020. By the first week of March it was obvious that major challenges were on the horizon in the USA, despite the ‘fake news’ assurances of the Administration.  The fact that this is a global pandemic is brought home to me by the fact that it affects my son Roman in Moscow and my son Vlad in the army in Iraq just as much as me here in North Carolina.

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Photo by cottonbro on Pexels.com

But my own personal story of 2020 has taken a turn that sent me on a different, yet oddly parallel course. Back before Thanksgiving I had my annual physical where I told Dr. Dough I had noticed something going on with my breathing- that walking fast, walking uphill, working hard out in the yard, caused me to have shortness of breath and tightness in my throat. No pain, just odd pounding heart beats. He scheduled me to meet with a heart specialist, Dr. Munley, who proposed a CT scan at Moses Cone. In February, after it had finally been approved by my insurance, I drove myself to Greensboro and had the scan inside the big magnetic doughnut. The next day Dr. Munley called and wanted me to come back to his office; he was recommending that I have a heart catheterization as soon as possible. The CT scan on March 12th showed that the arteries in my heart had some serious blockages, and the cath procedure could pinpoint where they were, and even insert stents to open them up if they were mild or moderate. He recommended that I go back to Moses Cone for the next available catheterization slot, not only because the results were worrying, but because the thundercloud of COVID-19 was blowing up on the horizon. He didn’t want me to delay and at best risk being hospitalized with virus patients and at worst having to delay surgery until the pandemic was over. That weekend the coronavirus began to assume the aspect of a real crisis, as cities and states began to cancel public events, close restaurants and bars, and event cancel entire school years and professional sports seasons.

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On Tuesday, March 17th, my sister Jill drove me to Greensboro. She had come up from her home in Morehead City because I wouldn’t be allowed to drive home or be by myself after any procedure. It seemed lucky that I would have Dr. Kelly doing the catheterization on St. Patrick’s day, and I hoped I would get a stent or two and be on my way home by dinner time.

That didn’t happen. I was awake during the catheterization, watching on a big TV as they pushed a wire through my wrist and poked around inside my heart, using dye to show blood flows and blocks. The bad news was that four of the arteries feeding blood to my heart had blockages; one of they was almost 95% closed. They set me up for the next available heart bypass surgery, two days away.

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Swept up in events, I became something little more than an interested bystander to my own health care. The surgery schedule was being pushed not just by my condition, but the looming spectre of the potential collapse of the health care system. After I became a piece of the puzzle on March 17th, events rapidly began to cascade. The hospital was closed to all ‘elective’ surgery (cardiac problems were considered mandatory); visitors were limited; and the news from other states began to look grim.

Those two days waiting were filled with tests, so many different tests that had to be done before surgery that I began to wonder how anybody suffering an actual heart attack ever got into surgery in less than 48 hours. They said they can hurry it up when they have to, and it was unusual that I had the luxury of time. Everyone seemed to agree that it was odd that I hadn’t had chest pains, or any other symptoms besides shortness of breath. They also said I was an odd cardiac patient in that I was generally healthy, did not smoke and did not have diabetes. What I did have, though was a family history of heart issues: my father died at age 59 of his first and only heart attack; his father died in 1964 at Moses Cone of complications from heart disease; my brother had had a catheterization years ago. I didn’t eat read meat and barbecue; I thought I had a pretty healthy diet. Just as some families share histories of cancer, others just have cardiac problems written into their DNA, the doctors said.

Very early that Friday morning I was awakened for a shave, not of my beard but of my legs, chest and anywhere else they’d be sticking needles or cutting. They rolled me into an operating room about 7:15, I met Dr. Gearhart and about two dozen other mysterious masked and gowned figures, and that was pretty much all I remember for 12 or 15 hours. I woke up in what I soon knew as the ICU with a breathing tube stuck down my throat, and about two dozen other wires and tubes anchoring me pretty securely to the hospital bed. Time telescopes in that situation; I can’t say how long I lay there in a gradually lifting fog. The nurses said that I began to come out of the anesthetic surprisingly quickly, responding to questions and instructions. I think the breathing tube came out some time Saturday morning; maybe it was earlier in the night. After that I could talk, with some difficulty

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At some point Saturday afternoon I was standing by the bed; early Sunday I up and walking around the room. The rehab people are very insistent on walking and moving ASAP, as this helps the rest of the body get back to normal. As I learned, my bodily functions had pretty much been turned off for about 8-10 hours while I was on the heart-lung machine. My breathing stopped, my lungs deflated; my intestines and digestion had stopped; my heart was stopped while they sewed four grafted veins to bridge over the blockages. The longest piece of vein, about 14 inches, came from my left leg; I was surprised to learn that it wasn’t all that necessary, and that blood flow out of the leg would reroute through other veins. Another piece came from my chest, as the most major part of the surgery was sawing my breast bone in half to get at my heart. This leaves me with a scar about 15 inches long that is the badge of honor of CABG (i.e., Cardiac Artery Bypass Graft, or open-heart surgery) patients. I’m told that this Frankenstein-esque scar is what puts us in the “Zipper Club,” though these days there are no railroad-track stitches or staples, they use super glue on the skin and it’s not so obvious over time. Underneath, however, there is stainless steel wire holding my chest together for 6-8 weeks while the bone heals, something I’ll have to declare to airport security from now on.

e57f9c51-e1f5-4538-a287-5fbe1f69647aRecovery in the ICU is measured not just by walking and talking, but in getting tubes and wires removed day after day. The electrocardiogram leads were the first I got, 8 of them even before surgery (another 8 during surgery, which came off Friday). Then there were IVs in both wrists, one in the left arm and one in the groin, which came out pretty soon. There were left and right chest tubes, to drain post-operative blood and fluid from the operation site. There was a Foley catheter, so I didn’t have to get out of bed to pee. And there was the “Central Line,” on the right side of my neck, a large IV-type tube that went straight into an artery and had about half a dozen other tubes branching out of it for various purposes. That, my sister said, was the thing that looked the worst.

IMG_1184The things that felt the worst, though, were those chest tubes. I’m sure my body was in some shock from the chest cutting and etc., but as I discovered, there was a morphine drip, and soon, Oxycodone taking the edge off that. But the chest tubes interfered mightly with breathing, and rehab people were very insistent on me breathing. Not that I wasn’t; a lifetime of asthma has taught me to be very aware of my breathing; but these tubes made it amazing difficult to breathe deeply or cough. (Or, God Forbid, to sneeze!) As if this wasn’t bad enough, what turned out to be my only major complication started Saturday afternoon and continued all through Sunday- burps, belches and hiccups. That doesn’t sound so bad, you say? Well, as I learned, when you’re cut open for hours laying on your back in the operating room, air gets into places in your body where air doesn’t normally go, and sooner or later it has to come out. Also, while open heart surgery doesn’t usually go anywhere near the diaphragm, which is a major breathing muscle behind the navel, the chest tubes to poke around in there and irritate it. And when the diaphragm is irritated, sometimes in some people, it responds with hiccup spasms. I was one of those lucky people. The older nurses knowingly said this often happened with women who get C-sections, and there is little to do short of Haldol, usually used to treat schizophrenia. Since I’d already had my first brush with all the scheduled pain killers I used to talk about in criminal court, I decided to avoid the Haldol. But dealing with those hiccups was agony, as every upheaval felt like I was about to pop open my chest stitches.

IMG_1220Gradually they became less frequent and finally stopped; One chest tube came out Sunday; the other on Monday, and that helped with the hiccups and breathing. Gradually my kidneys started to work again and get more of the meds and anesthetic out of my system. This was important as they had given my lots of IV fluids for several days, and when I finally weighed on Sunday I was 17 pounds heavier than when I went into the hospital- all water, they said, as I wasn’t really eating. On Monday that began to balance out, as diarrhea showed my digestion getting back in the game and eliminating lots of water at the same time.

By Monday I was out of ICU and on a regular ward, but by then no visitors were allowed of any kind, as the virus precautions progressed. What I saw on TV made being inside Fort Moses Cone look pretty good, as I walked around the hallways. As I had tubes removed I could try getting in and out of bed by myself, still a painful process which they drilled into me was helped by clutching my heart-shaped red pillow over my chest ‘wound’. The central line was removed on Monday, with a couple of the IV patches. The last thing to go on Tuesday were the pacemaker wires, which had been left inserted into the heart just in case they were needed before I left.

Tuesday afternoon I was given the green light to leave the hospital; I was progressing at least a day better than average, and Dr. Gearhart thought it would be prudent for me to go home before more virus patients started to arrive (Guilford county had 5 at that time; Randolph had 3). So I called my sister and she and Nina Foust came to get me. (First they had to send my clothes up through security, as when she left a week ago, they had her take everything with her). I was wheeled out to “Valet Parking,” valeted no longer, but access limited by police cars with flashing blue lights. That sobering first look at the way the outside world had changed in a week was my reintroduction to the new normal, life under lockdown.

Jill stayed with me at my house for another week, as I learned to move and maneuver, and as the pain and soreness lessened. The weather is beautiful, spring has sprung, and the end of March and first of April would be awesome except for the shelter-in-place, go out only as absolutely necessary rules. Not that I’m trying to push the envelope- doctors said not to lift anything heavier than a gallon of milk (8 lbs), not to rake, weed-eat, chain saw or otherwise work outside; and especially not to drive for at least 30 days, or until the doctor gives me a written release. (Twisting the steering wheel back and forth isn’t good for that broken breastbone, the one major issue that supersedes all other movements).

IMG_1206So I’m on the mend from open-heart surgery in the COFID-19 plague year, trying to heal up, deal with seasonal allergies that also limit breathing, and trying very hard not to get the virus that can lead to pneumonia. Hard enough to recover from one of the most major invasive surgeries, but now I must worry about an even worse problem potentially arising from every social interaction, Amazon delivery or grocery store visit. I’ve seen three actual people in the last week, one of whom took out the last chest tube stitches.

So March 2020 seemed to be about six months long, for a multitude of reasons. While this sudden illness has hit me hard, I’m on the road to recovery faster than most. And the fact that there are worse things out there than heart surgery was underlined the other day when I got a call from a newspaper reporter. “Do you have the Corona?, “ he asked. No, I said, I just had open-heart surgery with four bypass grafts. “Oh,” he said with obvious disappointment, “I heard you had the Corona!”

I’m thankful that I had an old traditional standby, heart disease, and that I had doctors and nurses and institutions so well versed in its diagnosis and care that I never had a heart attack, never killed any heart muscle, and should be radically improved by the end of the summer. I hope we are all radically improved by the end of the summer.

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