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Before the Storm
Five Months of Not Being Quite Right
It started, as these things often do, quietly and without drama. A little more breathlessness climbing the stairs, more breathlessness while bringing my daughter to the school with the bike, even more when trying for more. A heaviness in the chest after walking distances I used to cover without thinking. I told myself what we all tell ourselves — stress, work, age. I was 44. Engineers are problem-solvers; I diagnosed myself as overworked and moved on.
But the body is its own kind of instrument — it logs data whether you want it to or not. Over five months, the readings kept worsening. The progressive exertional breathlessness became harder to ignore, and when congestive heart failure entered the conversation, the diagnosis landed with a weight I wasn’t prepared for.
What Was Happening Inside
I had severe mitral regurgitation — my mitral valve, the one between the left atrium and the left ventricle, had stopped doing its job properly. Instead of closing cleanly with each heartbeat to push blood forward into the body, it was leaking. Blood was flowing backwards. The heart was working overtime to compensate, enlarging and weakening under the strain, eventually pushing me into congestive heart failure. In parallel, a coronary artery — the posterior descending artery — had become blocked. My heart was fighting on two fronts simultaneously, and losing on both. Root cause? It seems I have experienced multiple silent heart attacks, later discovered via heart MRI scan.
The Longest Night
April 21st. The Night Before.
I am not going to pretend I was brave. I wasn’t.
The night before surgery, I lay in the ward at Royal Papworth Hospital and I cried. Genuinely, openly cried — the kind you don’t do in front of people, the kind that comes from somewhere so deep it surprises you. I thought about death. Not abstractly, not philosophically — concretely, as in: what if tomorrow I don’t wake up? What happens to the people I love? What remains unfinished, unsaid, unfixed?
They were going to open my chest. Stop my heart. Run my blood through a machine. Replace a valve with a mechanical one made of pyrolytic carbon and metal that would tick for the rest of my life. Reroute a coronary artery with a vein harvested from elsewhere in my own body (my left leg). These are extraordinary things to do to a human being, and lying there in the dark, I felt every one of them.
When you genuinely don’t know if you’ll wake up, you discover very quickly what actually matters. It isn’t what you expected.
I thought about people I hadn’t spoken to in years. I composed apologies in my head that I’d never sent. I ran an inventory of everything left undone — not professionally, not practically, but in the quiet, unspectacular ways you fail the people you love. The conversations you kept meaning to have. The gratitude you assumed was understood. The care you rationed because life was busy, because there was always more time. That night, lying in the dark, there wasn’t. And the weight of that was heavier than anything physical.
The Operating Theatre
What They Did to My Heart
The surgical team — led by Mr Ng at Royal Papworth’s Cardiothoracic Surgery unit — performed two procedures simultaneously on 22 April 2026. It was long. It was hard. I wasn’t conscious for any of it, and yet somehow it feels like the most significant eight or so hours of my life.
They opened my chest via a sternotomy — a full vertical cut through the breastbone — and placed me on cardiopulmonary bypass, meaning a machine took over the work of my heart and lungs while the surgeons operated on a still, bloodless field. My failing native mitral valve was excised and replaced with a mechanical prosthesis. Mechanical valves are extraordinarily durable — they can last a lifetime — but they come at a cost: blood clots love artificial surfaces, so I will take warfarin for the rest of my life, keeping my INR (a measure of blood clotting speed) in the therapeutic range of 2.5–3.5 to prevent clots forming on the valve.
While the chest was open, the team also addressed the blocked coronary artery. In a CABG, surgeons harvest a blood vessel from elsewhere in the body — in my case a vein — and use it to create a detour around the blockage, restoring blood supply to the heart muscle that was being starved. One graft was performed: a vein bypass to the posterior descending artery (PDA). For this, I will take aspirin for life to keep the graft open and flowing.
Both procedures together constitute what is colloquially called open-heart surgery. There is nothing routine about it, regardless of how many times a team has done it. I am grateful beyond words to everyone who was in that room.
Coming Back
Nine Days in the Ward. A Different Kind of Pain.
The surgery was successful. No significant intraoperative complications. When I came round in the ICU, breathing felt different — mechanically different, the way a restarted engine sounds different from one that had been running all along. My chest hurt in ways I hadn’t imagined. The sternum, once cut and then wired back together, reminds you of its existence constantly in those early days.
But the physical pain was almost secondary. The ward became a strange, suspended world — a liminal space between the life I’d had and whatever came next. Machines beeped softly. Nurses moved with quiet efficiency. And I found myself doing something I hadn’t done in a very long time: just thinking. Not problem-solving. Not optimising. Just sitting with thoughts I’d been outrunning for years.
The strangest grief surfaced in those days — not for what I might have lost, but for how much of the living I’d been sleepwalking through. You build a life, and then you fill it so completely with doing that the being gets crowded out. I thought about the version of me before diagnosis, moving at pace, head down, treating urgency as a virtue. I didn’t feel angry at him. I felt something quieter. A kind of sorrowful tenderness, the way you might look at a photograph of someone young who didn’t yet know what was coming.
There were visitors. There were calls. Some I hadn’t expected. Each one landed differently than it would have before — with more weight, more texture, more gratitude than I knew how to express out loud.
The surgery repaired my mitral valve. Nine days in a ward, with nowhere to go and nothing to distract me, began to repair something else entirely.
The Post-Op Picture
My post-operative echocardiogram showed the mechanical valve well-seated and functioning correctly. My ejection fraction — the percentage of blood the heart pumps out with each beat — came back at 45–50%. That sits at the lower end of normal, which is entirely expected in someone who has just had their heart stopped, operated on, and restarted. The heart needs time to recalibrate. ECGs, blood tests, and chest X-rays were all satisfactory. The physiotherapy team cleared me for mobility. Some days after admission, I was discharged home.
Life After
Going Home With a Different Heart
Home. The word felt enormous. I walked back through my front door and stood there for a moment, aware that the last time I’d left it, I hadn’t known if I’d return.
My daily reality now includes things I never thought about before. I self-inject enoxaparin — a blood thinner — while my warfarin levels build up to therapeutic range. Warfarin is a notoriously sensitive drug; diet, other medications, even stress can shift how it works. The INR has to be monitored regularly and kept between 2.5 and 3.5, which for a mechanical mitral valve is non-negotiable. Too low, and there’s a risk of clots forming on the valve — catastrophic. Too high, and bleeding risk climbs. It is, in a very real sense, a lifelong calibration task.
If you listen carefully in a quiet room, you can hear the mechanical valve click. A small, precise sound, completely regular. It is, objectively, one of the stranger experiences of my life — listening to the sound of my own survival.
What I Carry Now
The Emotions Were Denser Than the Physical Pain
That sentence is exactly true and I want to leave it there, unembellished, because it says everything.
I am an engineer. I spend my days thinking about bioreactors, control systems, data flows, ML models. I am comfortable with complexity, with uncertainty, with iterative problem-solving. None of that prepared me for the particular kind of complexity that is facing your own mortality in a hospital bed the night before someone cracks open your chest.
What I discovered in those days — in the crying, in the stillness, in the ward at 3am when the ward was quiet and there was nothing between me and my own thoughts — is that the heart is not just a pump. Every cardiologist knows this, even if they don’t say it. It is where we keep things. The love we meant to say louder. The people we took for granted. The version of ourselves we kept promising to become. And sometimes it takes a surgeon’s hands inside your chest to remind you of what you’ve been keeping there, and what you’ve been neglecting.
I am home now. My chest is healing. The valve clicks. The INR will be checked. The follow-up at the cardiothoracic clinic will come. Life will, slowly, resume its shape.
But I am not the same person who walked into Royal Papworth on 21 April. I don’t think I was supposed to be.
Survival is not the end of the story. It is, if you let it be, the beginning of a better one.
Gratitude
To Everyone Who Was There
To the surgeons, anaesthetists, perfusionists, nurses, physios, and every single person who was part of my care at Royal Papworth Hospital — thank you. What you do is extraordinary, and you make it look ordinary, and that is a remarkable gift you give your patients.
To my loved ones who called, who came, who sat with me — thank you. You have no idea what those moments meant, or perhaps you do, and that is its own kind of grace.
And to anyone reading this who has been putting something off — a phone call, a conversation, an apology, a reconciliation — please don’t wait for a hospital bed to prompt you. The people in your life are not going to be there forever. Neither are you.
Neither, it turns out, was my original mitral valve. But that’s what surgeons are for.