Surely, I thought, there must be some mistake. Medical psychologists have a word for this: denial.
“When might this be done?”
“As soon as possible. We could send you home, but I recommend you stay until you have surgery.”
So much for denial. At this point, resistance would have been, if not futile, extremely foolhardy. I spent a long, ruminative weekend at the hospital. My roommate was an elderly European, recovering from the very procedure I would soon be having. He moaned through the night – comforting neither as sound track nor as omen.
The risks, I knew, were not trivial. With my son, Sam, a lawyer, I drafted a handwritten will, something I had managed to avoid doing for too many years.
Early Tuesday morning, a male orderly arrived to shave my chest. A nurse delicately – okay, as delicately as she could – administered an enema.
My daughter, Susan, working in California, had flown home. In my hospital room that morning, we decided to Google the ratings for my surgeon, Terrence Yau. They were glowingly positive.
“Yeah,” I said, trying to joke. “He probably got his mother to write them.”
At that moment, Dr. Yau entered the room, not (I could only hope) having heard me.
He was straight out of Central Casting – erect, focused, succinct, exuding confidence. My case, he said, looked straightforward. He anticipated no complications, but he was required to note that a small percentage of patients don’t survive, and a slightly larger percentage suffer strokes and other disabilities.
The good news, he said, was that, notwithstanding my blockages, the heart muscle itself appeared healthy.
My attitude was one of sober resignation – the approach I take whenever I board a commercial airliner. Whatever happened next was entirely beyond my control. I was consigning my life to the pilot, Dr. Yau.
Bypass operations have come to seem routine – after all, more than 500,000 are performed annually in North America. But cardiac surgery is still a relatively recent development (the first successful one was in 1960 in New York) and not something to be taken lightly.
After anesthesia, the surgeon saws open the sternum (breastbone) and removes segments of the thoracic artery and the leg’s saphenous vein to use in bypassing the blockages. The surgical team then goes “on pump,” turning off the heart as if it were a light switch. The pump, or heart-lung machine, does the heart’s work while the grafts are connected to the coronary arteries (at one end) and the aorta (at the other). The engine of the heart is then rebooted, excess blood is drained from the chest cavity, and the broken breastbone wired back together.
After the wound is closed, the patient is shipped to the intensive care unit. Barring complications, the procedure takes about four hours.
In 2005, Francis Duhaylongsod, a surgeon working in Hawaii, developed a new, minimally invasive technique that requires neither breaking the breast bone nor using the heart-lung machine. Instead, three small incisions are made, allowing access to the heart. As a result, healing times are faster and the risk of infection reduced. Only two hospitals in the Toronto area – Sunnybrook and Trillium in Mississauga – offer the new approach. But I was not a suitable candidate for the procedure, or so I was told.
I was soon out cold and would remember nothing
The cavernous operating theatre was lit like a movie set. The anesthetist, a muscular Russian, began attaching intravenous lines. A brief discussion of my case would precede the procedure, he started to explain … I was out cold before he finished the sentence. I would remember nothing – no white lights, no tunnels, no ethereal voices, no out-of-body experiences.
I awoke in a stupor, my mouth full of tube. My body had become a motherboard, a matrix of wires plugged, it seemed, into every part of me. My loved ones, gathered at bedside, stared collectively aghast at the sallow-faced ghost that lay before them. I was only dimly conscious of them, but did somehow register the extraordinary attentiveness of my ICU nurse, who patiently explained everything before she did it, with care and tenderness.
Dr. Yau’s assumptions had been justified. When he met my family afterward, he said the surgery had been “boring, but in a good way.” On the other hand, my blood pressure had dropped precipitously, and more than 12 pounds of dopamine solution had to be injected to elevate it. I would spend the next six days in intensive care, about four more than is customary, while my blood pressure stabilized, and four more on the regular cardiac ward, while I expelled the excess fluid. Only when my body weight returned to pre-surgery levels would I be released.