Heart attack, Part 5: Surgery approaches

Fifth in a series of articles about the author's heart attacks.

Dr. D's scheduling my surgery had left me feeling like Wile E. Coyote after encountering a steamroller. But the next day, Dr. M, my cardiologist, said, "Forget everything Dr. D said. He overstepped his bounds. I will decide if and when you have surgery. Your job is feel better and grow stronger."

At the third session with my physical therapist, I walked, cane in hand, 20 feet, down the hill our house sits on, to the corner and back. "Congratulations," she said, "you've graduated." The next day, I walked ten minutes on flat ground. Three days later, I did 16. Then 20.

I made other gains. Before bed, when Adele and I read to each other, my portions grew longer and resonated with greater volume. I met friends in cafés, resumed espresso and spiced the festivities with the occasional mini-canolli. I exercised with two-pound weights and, afterward, lay in my health club's sun. If people asked. "How are you?" I replied, "Good."

But I still needed pills to sleep. I experienced coughing fits, dizziness and narrowing of my visual field. I bruised easily, and each black-and-blue mark worried me.

Unanswered questions

Dr. M's directive to reduce sodium cost my diet pastrami, pickles, pretzels and the entire cuisines of China, Japan and Mexico. My weight kept falling... 163, 161, 158. My systolic blood pressure hung in the high 80s or low 90s. With each new reading, surgery seeming to draw closer.

I wondered to what extent I would recover, how long it would take and who I would be when I got there. I was accustomed to viewing myself as healthy, vital, engaged. Now I felt damaged, frail, vulnerable to nature's whims. I planned to update my will.

Instead, my optimism returned. I reminded myself that I had survived two heart attacks that fell from the blue. Why shouldn't I survive an operation, surrounded by an entire hospital? I had nearly died, twice; but now I was fine— albeit bearing seven stents. In a sense, I was one lucky son of a bitch.

Riding this view, I accessed pleasure in unaccustomed places. Waiting in supermarket checkout lines while customers ran back for broccoli or chatted with cashiers about dry rot no longer annoyed me. I replaced my cane with a bone-tipped, silver-handled, ebony walking stick.

Is surgery avoidable?

My improvements pleased Dr. M. So did my blood work and lungs. Though my heart murmured, it did everything asked of it.

Surgery now appeared avoidable. Certainly, it wouldn't be rushed. Dr. M wished my medications to have time to improve my heart's functioning. Summit Hospital needed time to approve a device that could keep me alive if my heart failed during the operation. Meanwhile, she said, I should reenter cardiac rehabilitation.

That shook me. My last rehab effort had ended when I was wheeled out, unconscious, on a gurney. And what was that about heart failure?

"Mr. Miracleman!" a rehab nurse greeted me upon my reappearance.

The rehab people babied me. But one night I woke with my heart beating twice its normal rate. When Dr. M's carotid artery massage failed to correct it, she booked an electric shock.

"I've done a million," she reassured me, "and no one has ever died." It returned me to rehab, but, a week later, my tachycardia recurred.

Dr. M tried medications. One required me to give blood twice weekly in order to monitor its effects. But before my first vein was tapped, she reviewed my records and declared it unnecessary.

Mixed emotions

The second medication normalized my pulse but caused me to gain five pounds, dropped my blood pressure to new lows, and adversely affected my thyroid. Dr. M, concluding that my risk of a stroke from an arrhythmia was slim, ordered me off it. My weight, blood pressure and thyroid returned to their previous levels— and my heart stayed in rhythm.

My confidence swelled, but I was pissed, too. I had expected a run of good feeling. The tachycardia had surgery re-knocking on my door.

"Think we'll ever feel good?" Adele asked.

"Sure," I said.

"I hadn't expected to spend your retirement like this."

"I certainly expected we'd eat out more."

"I could live comfortably at this level of function," I added. "But I'd like to be able to carry groceries from the car."

I wanted Dr. M to tell me, "Things are improving. Let's wait." Instead, she ordered an echocardiogram. "The medications have done all they can," she explained. "Your heart is functioning better than expected, but part of it isn't working. It's only pumping half the blood it should. It's time to correct it."

I am blessed, I thought. I am healing...

Thinking abut a transplant

"You are young and thin and fit. Your other organs are fine. You have a 99 percent chance of coming through the operation."

She promised to pick a surgeon and hospital as if she were choosing for herself.

The hospital was in San Francisco. Its chief surgeon had agreed to operate, not supervise while an associate wielded the knife. The chief cardiologist would attend me too. The device Dr. M liked was available. If necessary, I could receive a heart transplant there. That was the first time that had entered the conversation. Each step forward seemed to expose a deeper pit to view.

The shadows cast by my last hospitalization darkened everything we heard. Adele revealed details she'd kept from me before. Six doctors had worked on me. Every hour, one of them had emerged to say he didn't know if I would survive. When I did, they were amazed.

Now Adele feared being unable to talk to me again. She wept if we separated even for five minutes. She dreamed that a surgeon told her, "He didn't make it," and she died on the spot.

Reassuring arrogance

The arrogance of Dr. G., my new surgeon, was as thorough as Dr. D's had been but vastly more comforting. When he learned Adele and I were writers, he told us he had majored in English at Harvard and quoted Alexander Pope. He described the workings of the heart (presumably for the one-millionth time) with zest. Though he'd performed countless operations, he said they still enthralled him. He did not clout us with fatality figures, as Dr. D ha done, but slipped it in (5 percent) in between chuckles. When he learned that Dr. M had considered Stanford for me, he unhesitatingly claimed superiority to any surgeon there.

"The operation will take three hours," he said. "You'll spend a week in the hospital. You'll feel like a Mack truck hit you. Then a car. Then a bicycle. You'll want to hibernate, withdraw, be left alone. But start moving; start building up; keep at it forever. The heart is a muscle. It likes that."

A friend volunteered to drive us to San Francisco. Another volunteered to sit with Adele while I was under anesthesia. A third offered his house key if she needed a place to crash or shower. She settled for a hotel within walking distance of the hospital that offered special rates to relatives of in-patients.

Betting on new boots

We were somewhat relieved the decision was made. I would get this done, I thought, and begin again. If a positive attitude would help, I had one. I treated myself to marked-down Mark Nason boots on-line, demonstrating $175 worth of belief I would survive to wear them.

Meanwhile, my doctors feuded. Dr. M told Dr. G to go in, fix my valve and get out. "You don't need these other things," she said. "They do them wrong or fix the wrong places. If you need a pacemaker in the future, you'll get one. I want you out of the hospital ASAP."

But Dr. G convinced her he should perform any bypasses he saw the need for. I felt like a lamb chop, with chefs debating my garnishing.

An angiogram was ordered to confirm that I hadn't registered a false positive. It was good.

The doctor was surprised

"You're such an interesting case," Dr. M said. Months earlier I had been advised to hope I never heard those words from a physician. I grasped at the belief that I would emerge healthier than ever, embarking on the next phase of my life physically rejuvenated and a deeper, wiser person.

When I entered the hospital, it went Bang! Bang! Bang! Questions, IVs, blood samples, physical, X-rays, doctors' visits. One, having just read my chart, blurted his surprise at how healthy I looked.

The only foreboding portent was that the nurse shaving me nicked one of my testicles, and, despite my having been off Effiant for ten days, I bled and bled and bled.

I am loved; I am joyful; I have faith; I will be healed.

I wouldn't write another word in my journal for 23 days.♦


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To begin the series at the first episode, click here.