CORONARY ARTERY BYPASS GRAFTING X5 - MEANING: MEDICAL AND PERSONAL

I. INTRODUCTION:

Coronary artery disease: symptomatic. Exertional angina. Angioplasty strongly positive for 5 vessels stenosis and need for coronary artery bypass grafting x5 asap.

This couldn’t be my diagnosis or treatment plan.

Although male and age 66, I am not overweight. I don’t smoke. I don’t drink. I do exercise. My high blood pressure is well controlled on medication. I don’t have high cholesterol or high triglycerides. I don’t have any of the risk factors for premature coronary artery disease, let alone 5 vessels stenosis requiring coronary artery bypass grafting asap.

Oh yes. There is that issue of positive family history. And that alone may be a sufficient marker for coronary artery disease and need for a bypass surgery.

My maternal grandfather had a heart attack and a heart condition for years.

My father and his brother, my uncle, had fatal heart conditions.

My cousin, a man my age, recently had bypass surgery.

So, yes, the genes do tell the story and provide an adequate and sufficient explanation for symptomatic advanced coronary artery disease and multiple stenosis, especially of the critical left anterior descending artery, a/k/a “The Widow Maker.”

 II. DIAGNOSIS:

My diagnosis was serious, but treatable.

It turns out that coronary artery bypass grafting is not the surgery it once was.

Many men and women have it every day in the United States, with excellent results, and a fatality rate that hovers at just about or slightly above 1%. A far cry from the 40% or nearly 50% of the patients that were lost on the table in the ‘60s when the procedure first started.

So, coronary artery bypass grafting x5 is the preferred procedure I needed to treat my coronary artery disease, to get better, and to return to an active life and law practice.

 III. THE WAITING GAME:

Fortunately, or unfortunately, I learned of my diagnosis while on vacation, in Florida, in mid-January, 2019.

Fortunate in the sense that the exertional chest pain was identified as advanced coronary artery disease requiring corrective open heart surgery, after angioplasty.

Unfortunate in the sense that, although surgery was indicated quickly, on vacation, in Florida, Naples Community Health Center was not the place for me for such major surgery.

I opted to return to Massachusetts and to schedule open heart surgery with a preeminent cardiothoracic surgeon, at Mass General Hospital [MGH], Boston, MA.

MGH is a center of excellence for cardiothoracic surgery, rated in the top 1.2% of all cardiothoracic surgical units in the United States by the Cardiothoracic Surgical Professional Association.

But with clinical excellence comes surgical volume.

A large number of patients waiting for necessary open heart surgery, from New England and beyond, while MGH also performs emergency surgery as needed from its’ busy Boston ER Campus.

I, therefore, had to wait a month, from my diagnosis on 01/15/19, until my surgical treatment, at MGH, on 02/15/19.

And a month can feel like a year with active heart disease; a significant diagnosis with major bypass surgery to treat this condition.

I used this waiting period as effectively as I could by maintaining as a normal a lifestyle as possible, including work and family time, while steadying myself for the surgery.

Surgery was always on my mind. But, with sharpened attention to work, and a committed and supportive family, surgery was in the background rather than the foreground of my mind.

Fear, anxiety, uncertainty, all were active elements of my consciousness.

Despite being assured by my cardiothoracic surgeon that the fatality rate associated with this procedure, given my medical history and current health indicators [like age, weight, blood pressure, cholesterol readings, negative smoking and negative drinking history], made the probability of fatality only 1.2%, no reasonable person can approach and undergo this procedure without fear of death.

From my perspective, the valuable thing about fear of death was the opportunity to consider the value of my life, and its’ benefits and short comings.

I am no Saint. No one is.

I certainly have not lived a life free of regrets. But who has.

On balance, I came to see, and to feel, and to appreciate the goodness of my life reflected in my amazing family, friends, and life experiences.

No one was more supportive of my prognosis for good health, post surgery, than my wife and children.

Without their love and support, I would not be where I am today.

Other family members and friends all reached out, prior to my surgery, to wish me the best and to assure me that all would be well.

Based on this bedrock of love, support, and positive thinking, the day before my surgery, while listening to comforting seasonal contemporary music, I experienced an epiphany.

The epiphany is hard to explain, and even harder to commit to words. It was a warm feeling. It was a celestial sound. It was a comforting sense. 

It was recognition of a life reasonably well lived. Actually, a present sense of a wonderful life.

I vividly recall that completeness associated with sun, and light, and air, from a window overlooking the ocean, while seasonal/celestial music filled the room. My spirit sored and became one with my home, my family, with nature, and the sea.

It was an experience akin to that referenced by Eugene O’Neill in Jamie’s famous soliloquies about becoming one with the sea, nature, and the self, on two occasions while sailing in the Pacific in the great American Play, “A Long Day’s Journey into Night.”

It is possible to become a part of Nature, or the Universe, or God, on certain select occasions, when the spirit is willing, the heart is open, and there is an acceptance, rather than fear or rejection, of mortality.

During this epiphany, I was tearfully grateful for all who have made my life so wonderful and so worth living. I had no fear of death. If death should follow surgery the next day, so be it. I had all and more than could be expected from my life.

IV. SURGERY:

One of my daughters advised me that all I had to do regarding surgery was to, “Go to sleep and wake up.” In between, MGH and my skilled cardiothoracic team would do the rest.

I went to sleep. I woke up.

The surgery was a success.

The surgery was more complicated than anticipated. It did require 5 vessel coronary artery bypass grafting.

The surgery took 6 ? hours. A bit longer than 4 or 4 ? hours usually associated with this procedure. Apparently, my condition required a bit more time and skill. All went well. Although my family was worried when the surgery went into its’ 5th and then 6th hour, leaving the waiting room less and less populated with concerned family members.

V. Post-Surgery:

My left lung, for some reason, had a slight pneumothorax and didn’t fully inflate, for several days, delaying my discharge, from 4 or 5 days, to 9 days.

But I was home in time to see the Academy Awards, and have had a good recovery.

Post surgery, there is substantial pain and marked limitation. After all, open heart surgery requires surgery on the heart, with use of veins from the chest and legs to bypass multiple occluded arteries.

And it isn’t easy to get to the heart. You have to go through the ribs and chest with a saw and chest retractor.

And post surgery, tubes are in every orifice, including 3 chest tubes for post surgical drainage, best rest, and constant cardiac monitoring in ICU and coronary care.

So, pain, is incident to this type invasive procedure.

Substantial acute chest pain also causes confusion and depression.

Pain limits your ability not only to think clearly, but to eat, drink, walk, and engage independently in activities of daily living, etc.

MGH nurses were there to assist in the transition from acute pain, with no ability to walk, to managed pain, with increased mobility, leading to discharge.

The pain, post surgery, I found substantial, significant, and acute, and quite a bit more than I had anticipated or had been advertised.

A wise, experienced nurse explained my pain plainly, simply, and effectively: “Why wouldn’t you be in in significant pain? You just got hit by a bus that backed up and ran over you again!”

Opioids were a mixed blessing in addressing pain post surgery. Opioids caused pain relief with significant confusion and visual and audio delusions. Tylenol and Ibuprofen worked well when taken regularly.

Oxycodone made me see Games of Thrones on the nearest MGH computer screen, in Winter, with Games of Thrones characters on skis! The only problem: the computer screen was blank. My roommate, awaiting a heart transplant, was a Games of Throne fan and had an episode on his tablet replete with grand sounds. I “saw” his episode and “heard” his episode on my blank screen vividly, much to the consternation of my family! Soon thereafter, the oxycodone was discontinued and Games of Thrones characters and music faded to a distant memory, while the computer screen remained white but blank.

VI. RECOVERY:

Home recovery has been slow, steady, and certain, with less and less pain, and more and more activity.

It’s easy to walk up to thirty or even sixty minutes daily.

I hope to soon be cleared to return to work and driving when I see my surgeon on April 17th.

This seems a reasonable expectation, given my minimal pain, and ever increasing activity levels 6 weeks post surgery.

VII. LESSONS LEARNED:

What is the meaning and significance of open heart surgery?

Are there any lessons learned?

Can something good come out of such a sudden, major and painful medical event?

My answers are affirmative and positive.

The dire diagnosis forced me to confront my own mortality. We all know we are going to die. None of us know the day or the hour. But, when facing major surgery, certainly that surgical day has a greater probability of being the last day on Earth than any day prior thereto!

So, my heart disease and heart surgery compelled me to confront my mortality. I met that reality and found it inevitable, but satisfactory, based on a wonderful life.

66 years of life. Wonderful parents. A beautiful family. The best wife. All gifts that I don’t deserve. But I do recognize and appreciate with newfound clarity and candor.

And, if I do leave this Planet sooner rather than later, I leave with a sense of awe in nature that is grandiose and ever changing; a sense of gratitude for a wife and family that loves me unconditionally; and a sense of hope for humanity on a unique Planet in the vastness of space.

In terms of going forward post surgery, I aspire to a systematic increased activity level to stay healthy based on cardiac rehab.

I will maintain a heart-healthy diet.

Diet and exercise go a long way toward a healthy heart and longer life.

Stress, especially chronic, is a risk factor for coronary artery disease. Stress is endemic to the legal profession. So I will take steps to reduce chronic stress by making effective and systemic changes in my law practice, demand regarding travels, case load, and case selection.

I am grateful for my diagnosis, treatment, and favorable prognosis.

I am humbled by all of the support I have received from so many family members, friends, and clients.

This heart-felt essay is dedicated to Joanne, my beautiful wife, and my four extraordinary children, Marina, Estella, Evan, and Andy, who were there every step of the way, in this journey of health and heart.

I went to sleep. I am awake. I hope I am wiser, humbler, and kinder, not in spite of, but because of my coronary artery disease, heart bypass surgery, and family’s love and support.

Thank you to all, including my surgeon and the MGH cardiac care team.