Heart attack, Part 4: The prospect of surgery

Following my second heart attack, I stayed in the hospital for 16 days. I came out 15 pounds lighter than I had gone in. Before, men in my health club's locker room asked how I— at six-foot-three, 185 pounds— stayed so thin. Now I wondered if they'd ask what gulag I had escaped from.

The 20-minute ride home exhausted me. Climbing the 12 steps to our front door, I had to stop twice.

I woke up the next morning thrilled that I had survived a night with no one but Adele at the house"“ no doctors, nurses, therapists, X-rays, EKGs or other machines pumping and dripping and monitoring. But after washing my face and brushing my teeth, I couldn't shave. I was woozy and weak. I felt as if I'd forgotten the steps to waking.

I took the first half-dozen of my day's 20 pills with breakfast. That afternoon, I managed a ten-minute walk, leaning on my cane, up and down the hall, in and out of rooms.

The next few days brought no improvement. I was too anxious to sleep or nap without a sleeping pill or tranquilizer or both. Whatever the quantity or combination, I'd lie there for hours, my mind flitting from worry to worry.

Climbing the hill

I might fall asleep, wake at midnight and be unable to fall asleep again. Any ache or twinge in or near my chest made me wonder if I should call 911.

My blood pressure, which we took morning and evening, remained low. I was supposed to keep active in order to strengthen my heart, but the least effort exhausted me. I was supposed to keep hydrated and well nourished, but eating and drinking triggered coughing fits, because a breathing tube inserted in the hospital had scarred me.

The hill I needed to climb to reach where I had been, even before my last "event," seemed enormous. I felt, oh, two percent recovered.

Meet the therapists

The visiting physical therapist gave me a half-dozen exercises and a handout titled, "Yoga for the Heart." The occupational therapist suggested activities— wash a few dishes, prepare portions of a meal— to assist my conditioning. She also approved the redwood bannister by the front steps and the grip bar that our handyman had installed inside and beside the shower.

A nurse checked my vital signs— and terrified us with warnings about potentially lethal blood clots in my legs.

I wore support socks. I took my blood thinner, anti-depressant, stool softener, digestive aid, diarrhetic, aspirin, cholesterol reducer...

Tissues, a note pad and my cell phone rested on a table bedside the bed, reducing my need to leave it. My back rested against an inflated rubber "doughnut," positioned so the cyst that had burst during my hospitalization wouldn't be further inflamed.

I peed in a plastic bottle. I showered sitting on a chair. Adele wouldn't leave the house unless a friend babysat me.

Suicide in Switzerland

The first week, I went out only to have my dermatologist assess whether the cyst was healing without infection. It felt rather strange, walking slowly, unsteadily, feeling as frail as any of the walker-clutching, wheelchair-mounted, oxygen-toting patients entering the medical building.

Adele had been cleaning my wound, applying disinfectant, wrapping it; and Dr. P. said it would have healed no better if treated by a professional.

I felt so grateful. I feared I'd never be capable of providing Adele the love and care and attentiveness— shopping, cleaning, cooking— she'd provided me.

"You'll get help," she said. "Maybe you won't have to. Maybe we'll go to Switzerland," alluding to a clinic we had learned of that performed assisted suicides for anyone who asked. We had joked that we'd purchase one-way tickets to Geneva to keep with us at all times.

Dreams of Bill Clinton

I figured I owed Adele my best effort. I lacked any ultimate control over my course's outcome; but, then, what heart attack patient does? In this brave new world of mine, any day you awoke, you couldn't guarantee that you'd see evening. Although the uncertainty and dread that had swamped me receded, my reality was unchanged: My heart, if no worse, was no stronger.

I put my hope of recovery at 5 percent.

Slowly, things improved. I became less dependent on sleeping pills. My in-house walks now included a trip down and up our back stairs. I fetched the morning paper myself. I read my first book (a crime novel). I could sit up for two hours.

But I felt I couldn't get anywhere until I'd had the operation. And it seemed a bet against great odds.

One morning, Adele told me she'd dreamed she was in bed with Bill Clinton. He wanted sex, but she said, "Thanks, but I'm happily married." He settled for a kiss. Then she was in bed with Hillary. Hillary wanted sex too, but Adele said, "No. I already turned your husband down. I have a man I love."

"Was the kiss on the lips?" I asked.

"Yes."

"Tongues?"

"No."

"OK, then."

Angel of mercy

My second Monday home, we saw my cardiologist. In my not-quite three months as her patient, Adele and I had come to adore Dr. M, a blonde woman in her 40s who'd been born in Spain and spent many years in France. When we had doubts, Dr. M was positive. When we wavered, she exuded confidence.

We turned to her the way plants toward the sun. We appreciated that she registered our closeness. We sensed she cared for us too. Once, she said to me of Adele, "Elle est votre âme"— she is your soul.

After I'd described how I felt and she'd examined me, Dr. M eliminated two of my meds. She reduced other dosages"“ and doubled my Lexapro. My weight loss was no problem at this point, she said. It reduced the work of my heart, and, if it came to surgery, the surgeon would be pleased.

"He won't be slicing through fat," she explained. "He won't be thinking, "'I know there's a heart in here somewhere'.'"

Dr. M also said that surgery might not be necessary. By adjusting my medications, she might coax my damaged valve into behaving properly.

In any event, I shouldn't be swayed by anything the surgeon told me when I met with him: "To a hammer, everything's a nail."

I didn't know if she was just trying to keep me positive or if I might actually escape the surgery. But I would hear that line about the hammer twice more in the next few days.

Dr. D's grim news

Dr. D, an eminent East Bay surgeon, was stocky, solid, silver-haired, almond-skinned. The plaques and framed certificates on his waiting room walls honored his skill. According to my nurse, Dr. D had performed a quadruple bypass on his own father.

Our appointment with Dr. D was scheduled for 9 a.m. He saw us at 11:30.

The first thing he said was that the operation's fatality rate was 4 percent. Another 6 percent of patients suffered side effects, like kidney failure or liver failure or pulmonary embolisms or double pneumonia or a stroke or excessive bleeding, which they survived but that might require six months' hospitalization.

Then he said that the seven stents I already bore made the minimal invasion Dr. M had mentioned unrealistic. He would open my chest, which meant more risk, a longer hospital stay, and a longer recovery. And if I didn't have the operation, my chance of living five years would significantly decrease— might, in fact, be zero. To reduce the possibility of my having another heart attack first, the sooner I had the operation the better.

Each of his sentences pressed upon me like the Salem warlock hunters' stones on Giles Corey. A chest comes without thoughts or emotions, and to Dr. D, it seemed, I was another one to saw through.

Dr. D opened his appointment book.

"But Dr. M said I might not need surgery."

"You are my patient now. You will have the operation when I say."

His first opening was in three weeks. He wrote my name on the line.♦


This is the fourth in a series of articles by Bob Levin.
To read "My heart attack: a first-person account," click here.
To read his "Anatomy of a heart procedure," click here.
To read "Second heart attack: A survivor's tale," click here.
To read a response, click here.
To read the next installment, click here.