‘I had no symptoms’ - Horace Chang reflects on mortality after open-heart surgery

There was a change in the emotion, cuz now I was faced with open heart surgery, which in any I understand it and I know it's pretty routine and that we have competent people in Jamaica. A life spent in service met a moment of stillness when Jamaica's national security minister Horace Chang underwent heart surgery. An experience now prompting quite reflection from one of the country's most private leaders. Minister Jamaicans were concerned when news broke about your hospitalization. How are you feeling now? I'm feeling very good today and given the circumstances I'd say that I've done very well. I was treated very well by my my colleagues at the university and then the university health ecosystem from doctors, this intensive care um then of course physiotherapy all went very well. Um so I have I have no hesitation saying the University Hospital in their management of open heart surgery was excellent and I would say have any hesitation recommending to anyone. Yeah. You're known to be a very private individual. What made you decide to speak publicly about this experience? Um just a number of things. Remember at at the initial stage of course didn't want to over excite the wider public. So a statement was issued in conjunction with the conjunction with the with the Prime Minister that indicated I was doing surgery um but elective surgery. Which is a very common moderate way of indicating you're going to have a medical event. Um it was elective because I didn't have any symptoms prior to that. You would know the usual things that come with um heart problems, you know, shortness of breath, chest pains, instance of that sort. That was fine. I just want to campaign. And um, successfully run the campaign, which I did a lot of work. That's my style. Also, so maybe that kept me fit actually. On reflection. So, they indicated I would be out of service for a while because it had come on quite so relatively suddenly. I do my Well, let me go back a little bit. I did I do my regular medical checks and somewhat nearly 12 years back. I identified that there was some abnormality in my ECG. It was That's the electrocardiogram. And I attended Dr. Luis Montero Bay with my cardiologist. And she has treated me well. Well, she's very good. She treats me. And I have I see her every 6 months for some time. So, I've been following that line and the advice to anybody who reads this if you identify any cardiac problem, not just by electrocardiogram and any investigation, but my hypertension, cholesterol, etc. Keep your checks. Keep your checks. You don't want to get to surgery. Though I I did mine and I did get to surgery. But um, so I've been doing this and I went for um, a regular checkup. Um, in addition to that, I do some other medical checks and uh, she had actually sent me before to have a review in cardiac institute in Toronto, which is one of the best around. They told me the same thing she told me. So, I didn't see much point in continuing with them. And uh, she indicated I should do an angiogram after a number of Well, that was recently. The angiogram showed that I had a a slight block in one vessel. A partial block. Which really meant in today's world, stenting. Stenting is where uh, what we call an interventional cardiologist insert a that tube from up to your fear to one of the vessels at the you know forearm or on your leg into the heart and hopefully it will be a rich protection to your body. It has become very routine although it sounds exciting and traumatic. But you do it and you you rest for a while and get about your business. Um means no routine stuff but maybe the last almost maybe 40 years or so or more. So I figured it is so I I I at that point there I have it I did the angiogram early in August. I went through the campaign after the campaign I was still fine. So I kind of relaxed and Dr. Lisa had me know I need to get the further inspection done. So I went to Dr. Dr. Elliott who is a one of our um interventional cardiologist. And he realized that I they one passage that was visible and not the only problem. In fact I had three blocks and he needed surgery because they could not be stented. That was when they there was a change in the emotion because now I was faced with open heart surgery. Which in any I understand it and I know it's pretty routine and that we have competent people in Jamaica and I was I was not going to waste to do it. I could have you know moved on to any other institute in North America but ecosystem for me is the surgery in the university once you are comfortable with it. Professionals it is to me more comfortable. When you wake up and you sleep you know and you can talk with you understand your family can see and so forth. It is it contributes to your treatment. And you know people around the whole ecosystem the country is aware and know where I am. So I decided I really had to go there but the space thing up there was pretty pretty tough. Um all my surgeries maybe the most complex surgery you do in Jamaica. Um one or two other things are there. Um and you have to be you know you With Jamaica when you locked down you had to to work on it. It's like doing a It's like you take out the car engine to rebuild and then then the body lift behind. That's technically what we end up with. But I decided I'd do it and Dr. Irvine who was working with Dr. Henry had came down and saw me and explained to me what the severity of the problem which was was concerning because at that point he said it was not only was no choice it was quite severe but could be stented. In fact I at which point I just asked what time could you do it? Give me a couple days to tell my family. I'm the Prime Minister. And that's when the release went over that it we're going to do elective surgery that indeed it was by routine examination and we're going to do it. But that figure over time I'd have to speak about it because it was going to impair me for some time. And there a lot of concerns around and it went well if you need to know what happened to him. Where I am and if you go back there you'll have a better picture. But it was a that was a rough that's the rough part of it. As a medical doctor yourself did that awareness make the experience easier or more difficult for you? That's a difficult answer because if you don't know sometime ignorance assist helps you. And you fully understood what was going to happen. Not I didn't do cardiac surgery to tell you exactly what was required. And I I had the confidence in my own in the the team. and they are relaxed but I know it was a high risk situation. So. I was particularly. I said I was tense but it was of concern. It when you go into that kind of business you have to remember your mortality. That's that's the reality. And of course coming from a sick day. Besides family and friends of course I have the government to look at. Besides my colleague in the cabinet there's the ministry. I'm thankful that they are very capable team in the ministry who have been there for some years and it has evolved and. Prime secretary chief of staff commissioner of police and other heads of agencies they are all. In a kind of let's say a good reading they are working well they are competent and they are committed and. You kind of you could. You find it possible to kind of put the thing in the back of your mind and move on. And just face the reality of what is going to happen to you personally. That's actually the reality so I did it. And it it went kind of in quickly because. Um. I had had previous general surgery well ENT really where. A particular doctor who did my general surgery I said to doctor is he available and he was the one to do it and that he is he had to do it a little earlier than we planned. But it went in and. We spent the day in surgery now. We work in the university hospital. All right. Yeah and when I when I was out. I was greeted by. A young. Um and he said so said good. You know. Um doctor chance to meet you after surgery. Represents. Very refreshing said no way that reassured me that nothing wrong I've got. Nothing wrong wrong quite frankly. Uh this uh you know, young female was professional anesthesist and she had a she greeted with a warm smile when I woke up. I must tell you I couldn't have paid for that anywhere else. It was a a a Jamaican greeting you with that kind of I said uh um it was it was it was welcoming. It was welcoming but that was after that that was when you of course you had to go through a process. But intense pain so it was not just this pain was there until but it it went with I could sense it went well. As a physician that told me some of my anesthesist said that during this ordeal that stood out to you and one that may have changed your perspective as it relates to it and how long were you hospitalized for? Hospital in there in fact 2 weeks on the just over 2 weeks. In the hospital but I had to do 3 months after the intense pain. The rehabilitation and then I'm still doing rehab. It takes time for the whole body to recover. Bear in mind that you have you have basically a lot on your body. Move with your machine. Take back we started as they technical people in the surgery would say that the person handling the heart lung machine one of them is called a heart stopper. By by the way heart job is to stop your heart beating. Make sure it can it can be restarted. Handles your blood vascular system in the machine. In a manner that is keeps it healthy that is mean oxygenate your blood etc. put it back through the system keep your brain and your nervous system and the rest of your body working. So everything is in a different way they cool it down again. Significantly though you are cooled down quite a bit so you are not too the the metabolic system is at a manageable bit um level but one of them is called a heart stopper. They are there to stop your heart beating as I said. Then when you when you are reawakened, you have to make the restart properly. So, it is a But you're not aware of all that. The real moment of of any what you might call the reality sh- hit you was when doc said, "Look, Dr. Chang, you know the you know the reading. You do an angiogram. Then do angioplasty. If that angioplasty you do surgery." And I'm told I have to do triple bypass surgery. That that reminds you of your mortality and also as a physician begin to analyze the risk that you're getting into. But that was the single moment. All right. Well, I I recall asking my physician whether I could travel because I have a system which partly closed. I don't I don't travel out of the country. It's just maybe that's a good thing in this ministry because I let the rumor get out of course and my travel rights by someone in the ministry was but Well, ministry of national security for the first 8 7 years in Parliament were tough. Couldn't be flying out of the country and hear that you're a fugitive or a bad person on the ground. Nobody could find me or catch me somewhere in the air even if I would have my cup of coffee and relax here and so on and so forth. So, I didn't travel. I did very little traveling those years. I think I went to two or three security conferences and one in two different visits on law law enforcement in the United States. And they changed the commander so from what not much really. When he said I shouldn't travel because there's a risk increases I realized it was pretty risky. So, stayed put about the surgery. Thanks. And that went well. How did your family respond during this time or who or what gave you the most strength as you recover? The strength difficult to say how, you know, faith in uh having built up the level of confidence in the in the work done by the professionals, but I found those extremely supportive and some very good friends. Um in particular, of course, my wife who moved to Kingston during that time, my daughter who took over my telephone conversation. She took over the management of the life. Um Mr. Brown who is like family with my constant companion. That was my brother. The training officers, they all came in. And of course, my prime minister was always supportive, but his position was interesting. He advised all my colleagues not to disturb me too much. Allow me to go and they kept up kept abreast through um the doctor I mentioned before, but with a Dr. Irving um and who kept a Dr. Ellimaire who was nearby as well. Our professor kept in touch with what was happening daily. But they didn't come to visit me unnecessarily or too much. So, I'll say unnecessarily, but they didn't want to visit me until I was in a position to take visitors and they advised my colleagues just we'll keep you informed, but don't disturb. Much of this recovery phase in this kind of surgery is rest with activity, but organized activity the physiotherapist indicate. And allow you to say your body to heal and little to rebuild itself. As I said, you you have to little run the engine idle for a while before you start moving. And that was all. That was uh it. So, the support was all round very excellent. I get the messages. In fact, that's the was maybe what I have to call the the biggest support that I got tons of messages. Came to my daughter Melissa who was there right after. My son was there but it was Melissa kept the communication. And told him who called, who wanted to know what was happening, who they could do anything to help. And that was that was there. So she was excellent. National security is one of the most demanding portfolios. Do you think the pressures of public life contributed in any way to your condition? I would say no and that's not trying to be I would say that's that's not so much reality as cynicism. Um I I've so long been in public life I kind of take things in my stride. It's it's part of well you know me multiple ways. You say it's private but you're also trying to keep my focus on things that I've been from high school to university involved in some kind of of community leadership activity that was at college or that I was involved in. I don't know I was just a good sportsman you know myself and we organized sports were head boy and president of student association when to university president of the guild did all kind of things in the university. Getting to it of course when you get into the national government the emotional pressure is intense but if you seek to understand and keep focused works out. I never really had it so I never really had any serious medical symptoms. I had I've allergies I've allergies so I had to clear my sinuses and I'm glad I did that early. Not by pure coincidence. Last year um where my health things are once they said I spotted a some defect in my my heart muscles. And in fact by the time I got to do the clinical tests, which led me to surgery, I would not have had any hospital treatment. I just had a regular um six-monthly visit with Dr. Lewis. I maintained a very disciplined diet. Which is I think mostly a friend of mine. I think that's what kept me going. And I'm physically active. So I in fact was pretty good shape even in the pressures. What What necessitated the change in my lifestyle because the demand in terms of the time I my social life was it didn't exist anymore. I had I had be in the ministry for four or five days a week. Um tried to make it four days back in the country for three days. When you do the plan of three days, plan of Saturday, Sunday, you're trying to do seven days work in four days in Kingston, seven days work in the country in three days. That demanded a little bit of attention. That's social life was minimal. Um but I don't think it affected me physically. I think the activity may have helped to keep me because I remember Sir Donald Sangster and everybody I speak to who are experienced in the field, you did well in surgery because you were fit. So um What do you eat now? No, again, I'm a bit I have a lot of intolerance. So don't take any milky stuff. But I can eat everything and it's just that you have to moderate.