Lifestyle

In Praise of Croatian Public Health: My Triple Bypass Success Story

By 30 December 2021
Anatomical human heart in pen and ink, all rights reserved to the artist
Anatomical human heart in pen and ink, all rights reserved to the artist Copyright Lauren Simmonds©

December the 30th, 2021 - The Croatian public health system is faced with a lot of criticism, much of it is unfounded, here's my story.

Last spring was promising me yet another wonderful, very long, carefree and rejuvenating time down by the sea. Retirement is a blessing. It offers freedom of movement (plus freedom of speech if you enjoy it properly) and, especially, total command over one’s time. That's the bright side of it.

Time is man’s only true possession - everything else is precarious, ephemeral, temporary or illusional, much like our own bodies and physical states, for example. They're precarious, ephemeral, temporary, limited, and certainly not a supporting companion to our soul. I think that babies start crying seconds after their birth not because they are terrified by the new environment, but because they experience physical pain. Pain is man’s first experience of the world. Our body is not our friend, and it is less and less so as time goes by.

Health of course is tied to what one does on a daily basis to try to preserve it. Some attempts are futile, most aren't. Some people understand that early on, most don't.

I'm proud to say that my life allowed me to sin for a major part. A lot. Heaps more than most people I guess. I have seen more dawns than twilights, so to speak. Because life in general was generous to me (well, even during the war it was rewarding in many ways when I think of it), serenity prevailed by far over all of my days. When you're young, you are supposed to be all kinds of things when you grow up and you can of course do anything, including becoming an ''adult'' while still underage, because you need to keep up with the boys from your quarter, all of whom are your seniors by quite some years.

You cannot afford to be called a sissy if you didn't smoke, which you would be. At least back then. So I started smoking when I had barely reached the ''ripe old age'' of 16, when of course I knew everything there was to know about life, as did you, I'm sure. Later on, in the long years of studying and then freelancing around the world, partying and booze came into the picture, too, inevitably. Not that I'd get wasted every night, of course, but, well, there was lots of partying and many dawns, and many an estranged taxi taking me to where my bed was while missing my sunglasses and a bottle of water most desperately.

I remember discovering ''The Memories of Hadrian'' somewhere in my early twenties and re-reading that book several times over. Among quite a few memorable points, despite myself being young and utterly healthy, my mind recorded that moment when Hadrian started to become tired of his body which was becoming a nuisance, a traitor, limiting and disabling him. Almost one half of a century later, Hadrian has come to my mind so many, many a time. What a piece of work is man, Master Shakespeare wondered. Indeed.

When you think how you hated your granny (and your mother, and aunt and practically every adult around) who scorned you for not wearing a sweater, not having your shirt tucked in properly, sitting on cold concrete that would certainly make your kidneys ''go bad'', for going out (on a date possibly) with your hair still wet from the shower as a safe way of getting meningitis and inflamed sinuses, not to talk about lessons on how bad smoking is for you and how alcohol damages your liver… But who would listen? All of those irritating pontifications might have been true, but they had nothing to do with you whatsoever in your mind.

And then, how many times have you heard that somebody died of ''a sudden heart attack''? Sudden!?  It took almost all my life so far for me to learn that there is no such thing as a sudden heart attack. Such events, rare as they are, are freak ones. Every stroke or heart attack has its silent and deadly history built up in the years, it has its progress and, especially its cause(s) that live with you for a long time before that. You pay no attention, and then you're suddenly being transported to an emergency ward. Genetics play a role of course, but the cause is - you. Or, in my case - me. Also because my granny got on my nerves so much. 

The experience I had was more that terrible, and I want to share some of it.

I was in London some eight years ago when the very first rays of warning shone up inside my brain. One day I was walking from an underground station to the house of my friends where I stayed. It was an everyday routine, nothing special, and quite a short distance too. I might have been less than 100 metres from the house when I felt my right calf suddenly become stiff, further steps were oddly difficult, I started limping and hardly made it to the gate. The remaining several days were highly marked by that. I had pains when walking, I could not walk for long, either. It was sudden. It was frightening. That is when I was reminded of the not-so-good genetics pertaining to arteries in my family. There I was. It has caught up with me despite my lack of attention. I should have listened.

Back in Zagreb I hardly made it upstairs, dragging a suitcase along with me to my apartment at the same time. All alarms then began ringing inside me. This was no pulled muscle, and no self-resolving, passing ailment. One or two calls to my friends sent me to a hospital right away. There was a clog in my artery that had stopped the flow of blood to my leg almost completely and the operation, performed under local anaesthesia, was carried out by a young doctor who I made laugh heartily while he dealt with the clog.

When you must not move an eyelash for almost two hours, it feels much longer than it is.  I was alone in a spacious room, I had a TV, my own internet and actually had a good time within the circumstances, however ''disturbed'' by frequent check-ups and controls by medics. The care was total and complete and made me feel safe and comfortable. It was proof that the Croatian public health system, while underfunded, was beyond excellent.

This happened somewhere exactly around Easter Day and I was glad I could avoid traditional lunches and coloured eggs. That’s for kids, I find. Five days later I was back in the normal world with a clean artery and feeling quite good, quite normal again. I avoided driving and public transportation and walked everywhere I could. That is how you control cardiovascular diseases which only require conservative treatment. I soon forgot about that.

Pain gone and experience fading, I soon regained my old lifestyle. A thousand parties and no work, as Gertrude Stein defined the Thirties in Paris. Well, almost. Freelancing allows for that, as anyone who has dabbled in that knows well.

As a heavily addicted smoker, I wasn't aware of what I was silently but lethally doing to myself. Friends and family would warn and rebuke me, some strongly. I continued believing that the slogans on tobacco packages about death, cancer and other pretty things could not possibly affect me. Larger than life I was. Isn't cognitive dissonance a strange thing?

I could not bring to my awareness that getting out from a warm restaurant into freezing rain just to have a smoke made my granny turn in her grave while my arteries were getting more and more clogged by the day, by every single puff on a cigarette, by every single drag. My life was so good again, so why should I listen?

Some years went by, the uneasy feeling in my legs was growing once again, slowly but constantly, until I reached the stage when I could barely make a distance of 50 metres and was in almost constant discomfort. My calf writhing with each step as my body desperately tried to transport adequate oxygenated blood. In vain.  

It was a wonderful evening with a gang of friends of an international composition, with so much fun, laughter, totally uninhibited by ''Weltschmerz'' and the futility of life. When we had to change the place because of a rapidly approaching closing time, I realised I would hardly make it on foot.  The other place was less than 200 metres away. The final alarm was on. Again.

One call to a doctor friend put me in hospital almost the same day. During the first check-ups it seemed it was to be an easy intervention, then they took some blood, did some tests and found out that my blood sugar was above 20. It was too dangerous to operate. I was diabetic too, apparently. I had no idea what my body was suffering from, how could I have been so detached? How dare I feel surprised by my neglect? It was almost one week before they managed to bring it down to an operable stage.

I had peripheral arterial disease. An incurable but controllable arterial disease which affects the limbs, mainly the legs. My femoral artery was entirely clogged, and so were some others. Well, there we go. Another operation, a big one this time, with general anaesthetic and consent forms galore. I woke up after some hours, the doctors couldn't believe how brilliant my readings suddenly were, how my body which obviously was in dire need bounced straight back after being given what it needed. Instead of a longer sojourn in intensive care, I was taken quite quickly back to my room to recover. Yet again, more very good care at the hospital, another operation gone well, expertly well. It made me think of all those accolades Croatian medicine has been getting from all over the world. It is very deserved. Take it from me.

A few more years passed by. My left leg still had a few problems, some due to nerve damage following surgery, but it was truly nothing in comparison to how I felt before that last operation. I got used to stopping when I walked, waiting for a minute or two when I experienced claudication, and continuing. Naturally, I didn't feel enthusiastic about walking at all. My legs felt heavy and not willing to be exposed to any strain. Because of the pain it caused, although that pain was actually my saviour which would help to treat my disease, I started avoiding going anywhere on foot.

Unlike that first time, the famous blue Zagreb trams became my favourite way of moving around the city, and driving too. Then, my doctor scolded me, telling me that I must walk, walk and walk some more. By walking and straining the legs, you help your body develop more collateral blood paths, you help your heart, you help your - everything. I did reduce my nicotine intake, with lots of effort and self-control, but I could not abandon it altogether. By the way, for all you dirty smokers out there - I reduced the number of cigarettes by allowing myself to smoke only on the terrace, outside, never  inside the house. It helped. Maybe you could try that, too. It was quite an achievement for me who once smoked 40 per day, but I still couldn't quite kick it to the curb. Idiotic, I know.

My close friend, Lauren, started to force me to walk. We'd take long walks, not just to a cafe. She would get me to do it daily, again and again. I felt better. The splendid Maksimir Park offers infinite combinations and paths to stroll, for as long as you can or want to. I was forced to make at least 6000 - 7000 steps each time. For orientation, I could make some 200 in one go. Imagine the effort! I had to stop many times, but I did it. Never without losing my breath, panting or anything, never feeling that my heart was suffering. But to tell the truth, my physical condition was not exceedingly good. To put it modestly.

Fast-foward to April 2021. The leaves on the trees were turning green, everything was in blossom, Maksimir Park looks truly fabulous at that time of year, permeated with the birds’ twitter and the gentle breeze in the thick tree tops. As nice as all that is, as a Dalmatian from Dubrovnik, I was craving the sea. Addicted to the sea and, especially, to swimming - at least for 6 months a year, usually - I started coining my plan to go to the coast much earlier than usual and to make the ''summer'' a very long one indeed. I decided to have myself checked properly, to be sure I could spend several months in a village, far from my doctor friends in case, God forbid, I needed one. 

I contacted my friend, a renowned vascular surgeon from Zagreb, and asked him if he would be willing to check me up ''properly'', with scans and the works, as I really wanted to know what was going on inside me, especially inside my arteries. At one of those check-ups, I ''demanded'' that he check my heart. Without any apparent sign of anything. I just wanted to be sure. It might have been genetic hint from some of my ancestors from ''up there''. I had no cardiac symptoms that I could discern, it just came out of the blue.

How unfortunately right I was! My blood pressure was through the roof. I was suffering from hypertension which is high blood pressure, a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause heart disease. The ultrasound not only found some other little flaws in my heart, but three main arteries were more or less clogged. I needed a triple coronary bypass in an emergency procedure. I was ordered to stay in the hospital that same moment. In other words, I had to be under permanent custody, linked up to various monitors, as my heart could collapse under the strain at any moment. How and why I had not had a massive heart attack during those thousands of steps in Maksimir Park will remain a secret forever. A miracle, in fact, as told to me by my doctor.

An important reminder: there are very, very few sudden heart attacks. They only hit suddenly, when the silently struggling heart can no longer cope.

I did not have a heart attack, as the intervention occurred just before the inevitable happened, and I did not fear one. I told myself I should have that operation as soon as possible in order to be able to - go to the sea. Baby steps.

I spent two weeks in an utterly nice, freshly renovated ward, feeling alright under the constant telemetric control. I became used to the idea that I must remember the cables attached to me round the clock. To me, there were no signs or signals that my heart was penting up to provide enough oxygenated blood to the rest of me. Once again, to praise the Croatian public health system, it is so good when there is a bunch of communicative doctors and, especially, nurses with who you can share a laugh or two. 

I loved the sliding doors that saved everybody from being woken up by doors slamming somewhere down the corridor. I ignored the fact that I was confined, in detention, it was for my sake and for my good. I also ignored the fact that the pandemic and the inability to have visitors made this period of isolation more conspicuous, in some cases even very cruel. I had all the care I needed, my doctor friend (from another ward) would visit sometimes bringing with him absolute confidence and peace to my soul.

Tests, scans, readings, as the big day arrived. Taken by an ambulance to the central hospital to be operated on, an efficient nurse accompanied me to my new room and a new roommate, and luckily a very funny one. Sarcasm is one of my favourite assistants. New doctors, kind and caring nurses. Preparations for the operation, some not pleasant at all, but all done with patience and total care. The Croatian public health system succeeded very well in making me feel safe, despite all the huge question marks and worries hovering in the air and above my own head. 

The surgery was done. I woke up feeling that I was tied to a bed in an unknown space. It was so dark, just one lamp offered a slip of light somewhere in the distance, at some corner or something, my anaesthetic-induced blurry vision and confusion limited my understanding of my surroundings. My throat felt as if it had been cleaned out by a bit of aged sandpaper. I needed water. I tried to yell, but I produced no sound. I realised I was still intubated. I was helpless. I needed water. There was an attentive nurse on the sentinel who discerned my growling sounds in the dark. It wasn't just water this time, it was the blessing of all the Gods that ever existed to me at that moment. Sleep. More water. Several rounds, a few tests. After some indefinite time, they rolled me back to my room. 

The time of colliding with reality, with the seriousness of my body, had come to me. Thank you, Hadrian, you were so right and I hope you were not this sick and unable. I felt like a broken piece of old furniture chucked out into the street from the fifth floor. One slightest move of any part of my body hurt like hell. I felt like I couldn't breathe properly. I needed air. I needed water. I could not get up. I was even afraid to move my head on the pillow so as to avoid more possible pain. I was just one huge battlefield of all kinds of pains spiced with a total lack of energy, breathlessness and a most absolute state of helplessness. I had done it. I'd reached the absolute pits of my life, the lowest point, a very, very miserable point at that.

All I wanted and could do was sleep, but the attentive staff would not let me enter into a deep and healing slumber, they were in every hour to check on me properly. The care was total, but also irritating. I should've been grateful, not irritated. Yet I was helplessly irritated and wanted only to be left alone. 

The very next day there was a guy of very athletic physique who had a very deep and commanding voice: ''Get up, we're going for a walk!'' the voice said above me.

''For a what? You must be kidding, I can hardly lie on this bed…''

''You must walk, come on, get up!''

I thought I would die right there and then, and the post-operation ordeal seemed totally pointless. He helped me out of my bed with his strong arms, I let out a shriek as my entire body stiffened into a complete and utter pain. My legs were shaky, insecure, pains probed me at random everywhere. We did two lengths of the corridor. I lay back on the bed, depraved of life, in brief. I felt I'd done a marathon. They kept coming in and checking on me and asking me about this and that, taking my blood pressure, my temperature, giving me some pills, pain relief, food, checking on my wounds, measuring this, that, asking similar questions over and over. Irritating at the time, but what amazing care from the Croatian public health system this was.

My sarcastic roommate was released and it made me very sad back then, how I longed to leave this environment. Then, finally the day came when they told me I was going back to my original room in the hospital I was checked in at first. There I found out - I who have been fit and slim all my life, had lost a massive 8 kg. I dared to look at myself in the mirror and immediately thought I'd qualify as a photo model for a labour camp. Even my eyes had changed, they were sullen, sunken, looking back at me hopelessly from some hollow spaces, somehow from afar. My greying skin seemed to have belonged to someone bigger, my arms were like two pieces of dry smoked meat. It was horrendous.

After some days, some more blood tests, some more tests, some more questions, I was tested for covid and then released home. It was the very end of June. The temperature outside was around 30º C. I could make it to the kitchen owing to the help of my hands and door frames only, from one to another, aiming with concentration and focus. I had family there to help me and they couldn't do enough for me, which was a God send. My doctor friend came to check on me, to remove my stitches, to check my wounds. I began to walk, each day a little longer, I began to take my body as seriously as it had so nearly taken me for my negligence.

As I'm writing this six months later, I've put the weight I lost back on and I feel I belong to another, far more normal world with that wonderful sensation when you bend to pick something up and nothing hurts. I have taken up exercise regularly, even physiotherapy (another utterly professional service in the very heart of Zagreb), I try to walk as often as I can, to use my Orbitrek and, well, to be happy, meeting with friends for coffees and lunches with all serenity and joy, remembering well what Hadrian had eerily warned me of such long time ago.

Albeit at times when, indeed, there were also my grandparents and parents and aunts and uncles that I would not listen to regardless of their gender, age or advice. I was young enough to know everything, wasn’t I? Weren't we all?

Do not wait to be hit all of a sudden, don't harm your heart until it says no more, check your health thoroughly and profoundly, give up smoking (I know, it's preposterous coming from a filthy ex chain smoker of like 40 cigarettes a day), but if I can stop totally, you can too. Have a drink and be happy for as long as it lasts, because there is an expiry date and more often than not, it comes silently. 

Say what you want about Croatian corruption, politics, the lack of funding, the lack of... well, a lot. But Croatian public health stepped up and saved my life at the very last minute. There are a great many truly extraordinary doctors and other medical personnel in this country. Just in case you read this article with a cigarette in hand not having moved around for a few days... just sayin’. But why should you listen to me after all I have gone through? I'm not your mother, for God’s sake, so let me just wish you a Happy New Year - from my heart!

If you would like further reading material and/or if you're trying to stop smoking, it's worth noting that cardiovascular disease kill more people in Croatia than anything else. That's right, even the dreaded cancer comes second to the silent killer. Did you know there is an artery called the widow maker? There's a reason. Cardiovascular disease is the leading cause of death and accounts for more than half the overall mortality in this country. Furthermore, cardiovascular mortality has been constantly rising since the 1970s due to our dire habits.

Despite Croatia's observance of World no Tobacco Day, smoking is still killing many here, and it is continuing to cripple the Croatian public health system. Hrvatski dan nepusenja (The Croatian day of non-smoking) is also prominent. Can we reverse the trend? Be a part of it before it's too late.

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