Skip to main content

First Adventures with GitHub Spec-Kit - Spec-Driven Development from Hospital

· 13 min read
Mark Burton
Software Engineer & Technical Writer

A Most Agreeable Distraction

I dare say, dear reader, that after several weeks regaling you with tales of aortic replacements and pacemaker adventures, you might be rather relieved to encounter a proper technical post. Whilst convalescing in Kirchberg Hospital, waiting for my INR levels to reach their proper therapeutic range, I find myself with time on my hands and only my trusty phone and a modest tablet for company.

What better opportunity, I thought, to explore GitHub's spec-kit and attempt some spec-driven development? The goal, rather splendidly practical given my current circumstances, is to build an application to remind me to take my blood-thinning medication in the evening and perform my INR blood tests in the morning. I've imaginatively titled this endeavour the blood_thinner_INR_tracker.

Day 18 of Recovery - Home Time! Managing Blood Thinning and Planning Discharge

· 8 min read
Mark Burton
Software Engineer & Technical Writer

Monday, 20th October 2025 - Day 18

Day 18 marks a rather pivotal week in my recovery journey - the final stretch at Kirchberg Hospital. For the past week, whilst I've had the benefit of an echocardiogram to triple-check the new valve and a pacemaker check with settings tweaked to bestow upon it a most agreeable 15-year battery life, the principal focus has been achieving what the medical profession terms the "therapeutic range" for blood thinning. Rather crucial, as it happens, when one has a mechanical valve ticking away in one's chest.

Days 10-12 of Recovery - Transfer to Kirchberg and Cardiologist Care

· 6 min read
Mark Burton
Software Engineer & Technical Writer

Sunday, 12th October 2025 - Day 10

Day 10 was a very quiet day, two days after the pacemaker surgery. The focus was on waiting for news about the next stage of my recovery journey, though the delay in transferring to Kirchberg felt frustrating as it meant another day before ultimately getting home.

Day 9 of Recovery - Pacemaker Results, You Won't Believe What Comes Next

· 5 min read
Mark Burton
Software Engineer & Technical Writer

Saturday, 11th October 2025

Day 9 brought some pivotal moments in my recovery journey - pacemaker assessment results and news about the next stage of my care.

I woke up, you guessed it, in pain, but my breakfast was there so the nurse helped me get upright. At this point I was allowed to stand up but until we had the results from the doctors I was still confined to my room.

Day 4 of Recovery - Moving to the Normal Ward

· 6 min read
Mark Burton
Software Engineer & Technical Writer

Morning Routine in Intermediate Care

The pattern had become familiar by now - the night shift nurses arrived at 5:30 AM and had to wake me for the daily ECG. After another snooze, a whole new team of nurses arrived for the day shift. Unlike previous days, there was no X-ray scheduled today.

I was gotten ready for the surgeon's visit, who arrived with a big team of doctors and students in tow. He asked me if I needed the oxygen anymore. I gave an honest shrug - "I don't know." He told me he would check and, after confirming my oxygen levels were good, ordered the oxygen removed. Then came the good news: they were preparing a new room for me in the standard care ward.

The Move Across the Hall

No sooner had I finished my breakfast than a team of nurses arrived to move me to my new room. The journey wasn't far - all the way directly across the hall!

The transition brought several welcome changes:

  • Oxygen line removed: No longer needed, confirming my lungs were recovering well
  • Heart monitor upgrade: The continual monitoring equipment shrank to a portable Phillips MX40-2C4 that I can carry around my neck. It still sends all the data to the central nurse station, but I'm no longer tethered to a bedside machine
  • Mobile pacemaker: I still have to carry this around as well, though they mentioned it would be removed in the next day or two

The Temporary Pacemaker

The mobile pacemaker I'm carrying around is an Osypka Pace 203H - a German-made temporary external pacemaker commonly used after cardiac surgery. The device has electrode cables that were threaded through my chest wall into my heart during the operation, allowing the medical team to control my heart rate externally if needed.

The Osypka unit monitors and can pace my heart to maintain a steady rhythm during the critical early recovery phase. To my knowledge, it hasn't needed to actively pace yet, which is a good sign that my heart is maintaining its own rhythm well. The cables will be removed in the next day or two once the surgical team is confident everything is stable.

I have to admit, when I first saw the name "Osypka" on the device, my mind immediately went to oscypek - that delicious Polish smoked sheep's cheese from the Tatra Mountains. At least if I'm going to be tethered to a medical device, it can remind me of one of my favourite cheeses! Though I suspect the German engineer Dr. Peter Osypka who founded the company wasn't thinking about Polish mountain cheese when he named it.

Life in the Normal Ward

Now I'm in a nice quiet room alone. No more beeping machines, though there are still plenty of nurse visits, tests, and medicine to take. The quieter environment is a welcome change after the hectic intermediate care ward.

Physiotherapy and Breathing Exercises

The physio took me for a walk down the corridor, which went well. My mobility is improving daily.

She also gave me some more advanced breathing exercises to do, and I'm now using my Mediflo Duo respiratory exerciser at level 3 of 5. These exercises are crucial because of the discomfort and reduced activity - the temptation is to breathe superficially, which is bad for recovery. Shallow breathing allows bad stuff to build up, leading to coughing (which rates 10 out of 10 on the pain scale, even in the special braced position) and worse possibilities like infection if I don't do the breathing exercises properly and keep my airways clear.

The Mediflo Duo is an incentive spirometer with adjustable resistance levels that helps improve lung capacity after surgery. Starting at level 3 indicates good progress - it provides enough resistance to challenge the lungs without being overwhelming during this early recovery phase.

The "special braced position" I mention is essential for managing pain during coughing, standing up, or sitting down. They provided me with a recovery gilet (a padded vest), and the technique is to fold your arms across your body with your hands tucked into your armpits, essentially hugging yourself tightly. This braces and supports the chest incision area, reducing the stress on the sternum and making movements much more bearable. Without this bracing technique, even simple movements would be excruciating.

Despite the pain, I'm committed to doing the breathing exercises regularly. They're an essential part of preventing complications.

Progress Summary

Day 5 marks a significant milestone in my recovery:

  • ✅ Moved to normal ward
  • ✅ Oxygen support no longer needed
  • ✅ Portable monitoring equipment
  • ✅ Increased mobility with corridor walks
  • ✅ Advanced breathing exercises
  • ⏳ Temporary pacemaker still in place (removal soon)

The steady progression from intensive care to intermediate care and now to the normal ward shows good recovery. Each day brings more independence and fewer machines, though the vigilant medical monitoring continues to ensure everything heals properly.

Learning to Move Safely

I should mention that I did manage to get myself into and out of bed on a couple of occasions today, but I don't recommend rushing this milestone. The movement requires not just getting upright, but also spinning around - a complex manoeuvre that puts considerable strain on the healing sternum.

I've decided to work with the nurses for a few more days to master the progression: first, sitting upright confidently; then, standing up by myself; and finally, the full bed transfer. Getting in and out of the chair using the brace is manageable now - the pain is fine. But the bed is still a bit much with that additional twisting motion required.

I also realised I'd been forgetting an important step: adjusting the bed controls to put it in the optimal position before attempting to get out. The right bed angle can make a significant difference in reducing pain and strain during the movement. It's these small techniques that the nursing staff know from experience, and it's worth taking the time to learn them properly rather than powering through with extra pain.

First Days After Surgery

· 3 min read
Mark Burton
Software Engineer & Technical Writer

Post-Operation Day: Thursday, 3rd October

The first thing I was aware of after the operation was being extubated - not a nice experience, but I wasn't really very aware. My first comments, which nearly came out croaky because of the tube affecting my vocal chords, were "I'm alive" and "Is it Thursday?" Knowing if it wasn't Thursday, there must have been problems and I'd have an extra concerned family. As it happens, everything went smoothly, although my surgeon has since told me I had one of the worst aortic valves he ever operated on.

After that I was mostly asleep, only rousing to urgently apologise for snoring a couple of times and to ask what time it was - 2am and 4am.

First Full Day: Friday, 4th October

Morning in Intensive Care

The next morning started with an X-ray in bed and some of the tubes being removed. I had two in my neck and two in my arm. Over the course of the morning, that reduced to just one in my neck.

I was dragged out of bed and sat up in a chair for breakfast and for a few hours after. The physio came to see me whilst I was sat in the chair and I did the first breathing exercises, which was very painful. The surgeon visited and explained everything went well and I was making good progress, so I would be out of the reanimation (intensive care) ward that day.

At 12:00, lunch was served - fish, of course, being a Friday in a Catholic country.

By 13:00, they had removed the urinary catheter. That wasn't pleasant at all - burny and felt like I was going to need to pee straight away. They said it would feel like a urinary tract infection, something that I have no reference point for.

Moving to Intermediate Care

From 13:00, I was in intermediate care. Lots of monitoring going on, so quite hectic and noisy. I was overall in a much better state than I imagined I would be and had my first visitor. We did similar breathing exercises with the physio in the afternoon.

However, through the afternoon and evening the pain gradually increased. The pain I needed the extra medication for was mainly brought on by trying to breathe - quite a scary sensation as my breaths got shorter and shorter to avoid the pain, mainly around the chest drainage site. I buzzed the nurses for more pain relief, and it took two shots, but they made me comfortable and I slept well today, apart from the hourly blood pressure checks which startled me every time.