A Second Life Through Heart Surgery
At 53 years of age, I was preparing to die of coronary heart disease. I discontinued being a governor of a fine local hospital, phased out as Scoutmaster of a blue-ribbon troop of 41 exuberant Scouts, reviewed my last will and testament, and wrote a 5-page memo of estate suggestions to my wife.
Yet, I didn't want to die. I had a lot to ]jve for—family, friends, business associates and clients whose love, affection or friendship I deeply felt. I wanted to see them, be with them, and love them back.
For about six months my health had been declining noticeably. I felt mild chest pains when I exerted myself physically, or discussed emotional subjects for 15 minutes or more. I stopped playing tennis and paddle tennis, which I had enjoyed on a sociable (as opposed to a competitive) basis since my last heart attack in 1956, and I couldn't even walk the mile between the local railroad station and my home without stopping to rest. I consulted my New York heart specialist who prescribed relieving medicines which enabled me to walk and carry on more normally, but soon my chest discomfort occurred more frequently and thus increased my anxiety.
It seemed likely that within the next year or so, some sudden extra physical exertion during extreme cold or hot weather, some sustained business tension or emotional stress in personal life, or even some nightmare, would kill me.
Then I heard of the giant steps made in heart diagnosis and surgery during the last few years. A relatively new diagnostic procedure called cine-coronary-angiography (shortened to cineangiography) is now used in about 500 U. S. hospitals. Although cineangiography then had a mortality risk of about i of 1% (now running closer to 1/10 of 1%), it has much more diagnostic accuracy than the time-honored electro-cardiograph. So, I decided to assume the risk based on the statistics and what I had learned:
The cine-angio-graphy (translated: x-ray movie-heart-study) normally takes about 1 to li hours and hurts no more than the skin-prick of the needle needed to anaesthe- tize a small area inside the forearm. A small painless cut is then made in the artery, through which a catheter is slid (unnoticed by the patient because arteries have practically no nerves) to the coronary arteries. A dye is injected through the catheter so that a high-speed 35 mm. fluoroscopic motion picture camera (positioned over the prone patient's chest like an x-ray machine) can trace the flow of blood in the heart. This film then discloses various heart disorders, and their exact location, including the extent to which an artery is clogged. If the cardiologist's diagnosis warrants surgery, the film is later used by the surgeon as a "road map" to perform one or more of the possible internal mammary implants, coronary artery patch grafts, coronary bypass grafts, or aneurys-mectomies.
My cineangiographic study took about 55 minutes. After I spent a comfortable night in the hospital, the cardiologist explained his diagnosis to me and my wife the next morning: There was no immediate emergency in my case. Two previous heart attacks had damaged a significant portion of my heart, and one artery (which was about 75% clogged) was undoubtedly the cause of my chest pains.
Surgery was recommended for me before the cold weather set in—to avoid constricted blood vessels which overwork the heart. So, I evaluated the prospects and the odds at this point: If I did nothing, I might live a severely restricted life for perhaps a year or so. The type of surgery stipulated for me had less than 5% mortality risk. Neverthe-less, if I decided to take this 95% favorable risk and if I survived a successful operation, my long-term outlook should be much better. In addition, planning the time, place, and circumstance of my operation would probably improve the odds—com-pared to letting fate determine where, when, and how I would face this heart issue. To undergo heart surgery seemed the logical step.
Cardiac Company a Help
On a Saturday afternoon I was admitted to the Cleveland Clinic Hospital, where six of us were scheduled for various heart operations the following Monday. The patients were obviously apprehensive, but generally showed good humor. Everyone seemed to benefit from talking to other patients in the same pre-operative stage or to those patients on the cardiac floor who had been through the operation a few days earlier. It removed some shocks, which might be disconcerting later, to know that we were to be shaved from neck to knees on both front and back by an orderly the night before the operation, and to see the long uncovered incision and black stitches adorning the chest of a patient casually chatting in the hospital patients' pleasant lounge.
Sunday afternoon a briefing session was conducted by a cardiovascular nurse for all Monday-scheduled patients and their families. Typed information sheets were distributed. A post-operative oxygen breathing machine was demonstrated. The various chest-cavity drainage tubes, intravenous feeding tubes and throat tubes for removing after-surgery mucuous were explained. Patients were instructed how to cough—a vital necessity to avoid lung infection. Many questions were asked by patients and family members, all of which were reassuringly answered by the nurse:
"What if I should panic?" "Don't worry, we know how to handle that." "How much of the required supply of 10 pints of blood is used to prime the heart-lung machine to which I'll be connected during the operation?" "Three or four pints." "Is it true patients sometimes temporarily lose their voices as a result of the throat tubes?" "Yes, but not usually."
At 7:30 Monday morning, after a 45-minute visit with my wife, an orderly with just the right amount of cheerfulness and compassion in his voice came for me with the rolling bed-table used in the operating room. At 7:50 a.m. in the spotlessly white operating room—with good music coming over stereo FM—the anaesthetist swabbed my right forearm with a disinfectant, explaining that I would feel the pin-prick of a small needle followed by a moment of painless pressure. A few moments later he said, "I'm going to put you to sleep now, but you won't feel anything. When you awake, the operation will be over." Over and out!
There were two parts to my operation: First, my clogged heart artery was by-passed by grafting a piece of saphenous vein taken from my left upper leg; this was the critical part of the operation—with my "new artery" taking over its vital job immediately. Second, my left internal mammary artery, which runs down the inside chest wall was implanted into an area of my heart which had been damaged by previous heart attacks; hopefully this will eventually revitalize the circulation and function of the area by supplying a new source of blood. From start to finish, it took about 4½ hours. "A fairly simple operation—without complications," the surgeon assured me a few days later. It hadn't seemed so simple to my wife who anxiously but optimistically awaited news of my progress in the special family room where the surgeon telephoned at 10:30 a.m. to report: "We did what we expected to do. Mr. Dyer is being stitched up and taken to Constant Care. You will be notified when this is completed."
At 12:30 p.m. I was in the Constant Care room attended by doctors 24 hours daily, with about one nurse to each patient. At 11:00 a.m. the day after surgery my wife was allowed to visit me for five minutes. She was startled to find me so alert and sitting up in bed.
Following two days in Constant Care, I progressed on schedule and was moved to a double room still close to the special cardiovascular nurses and doctor. In this Intensive Care room I took my first post-operative steps. On the fourth day following surgery I was promoted to the Cardiac Convalescent section. It was a great but exhausting day. To be able to catch up on much needed rest was important, because Constant Care required almost continuous wakeful patient participation. Day by day my walking improved, my coughing improved, and more importantly my appetite increased. My wife was able to visit me from 11 to 1 and 4 to 8. She never stayed the full time, realizing I needed rest.
Each day after the operation I felt noticeably stronger. However, all of us patients had moments of emotionalism or depression—usually over some relatively minor complaint—including sleeplessness, soreness, numbness around the incision, voicelessness, etc. Obviously every patient didn't have the same complaints.
On the seventh day after surgery, the chest stitches were painlessly removed in about five minutes. On the ninth day, the leg stitches were out. It was home on the tenth day, where I was confined for two weeks.
Before leaving the hospital, I attended a preventive medicine lecture conducted by the hospital dietitian for patients and families. The importance of replacing animal-fat foods with unsaturated vegetable oils was stressed for us—and for our now-healthy children. Experts believe that heart-artery clogging starts unnoticed at varying speeds in most teenagers. Only when the fatty deposits inside the arteries have progressed in later years to a point of becoming a noticeable problem do we wish we had known and used the diets needed to avoid heart surgery.
Patients gathered for a special Homegoing Recommendations lecture by a staff physician and each of us received a helpful personalized booklet covering such items as physical activities, diet, medications, etc.
The first morning home, I awakened so early that I decided to arise and make my own breakfast. A week later, I picked up vines around the yard. One month after the remarkable operation, I returned to my office for two days in the week for four hours and I felt fine. I'll admit I was glad to be picked up by my wife and relieved to miss heavy traffic driving home. Daily walks of a mile or more helped to loosen the temporarily tight tendons in my left leg. I did more gardening, played the piano and worked daily on office problems. My chest incision was beautifully healed, but, oh boy, did it itch. This, too, finally passed. If you'll forgive the pun, I heartily advocate cineangiography and heart surgery.
While in the hospital the enormity of my emotional and physical experience hit me. It resulted in "My Love Letter to the Cardiovascular Nurses:"
"Although some individual first names and faces come easily and clearly to mind, this undisguised love letter is addressed to all nurses in the Cardiovascular Nursing Unit. To praise only the few who struggled successfully over me would be more personalized, perhaps, but it seems unfair to risk destroying an esprit de corps so important to life itself.
" 'Tender loving care' has always been associated with good nursing. Your daily passion for saving another's ebbing life in the post-heart-operation arena, and the self-realization that only your love and skill can make the patient respond both emotionally and physically to the desperately needed care, are motives far stronger than merely being a good nurse. Such dedication is obvious when one realizes that each post-operative heart patient was only a few moments ago actually 'dead'—that is, without a beating heart.
"From the moment a patient hears your name spoken softly into his ear—or can focus on your loving face, exuding understanding and confidence—or can feel your intimate, attentive, and skillful proximity—we patients want to respond wholehearted- ly. This instant emotional alliance is the essence of success for both patient and nurse.
"What of the knowledge, imagination, skill and wisdom of the doctors involved with the operation itself and the pre-operation procedures? As a patient, I admire and respect them. Because of them, I felt practically no operative pain. I now hope to have a healthier and longer life. However, this man-to-man emotion is distant and gradual—compared to the woman-to-man relationship felt so closely and quickly for you lovable nurses in postoperative cardiac care.
"So as I praise you, I salute you and thank you from the top to the bottom of my newly-repaired heart. As I love you for what you are doing—and how well you are doing it—God must smile warmly Upon you. Keep up the good fight, valiant cardiovascular nurses in white."
Sincerely and thankfully,
DAN L. DYER
EPILOGUE: At my six-week check-up, I was told that everything appeared satisfactory from the various tests and examinations and I could resume activities according to my own prudent judgment. Dunns the seventh week after the operation I hit numerous tennis balls with my 14-year-old son. By the eighth week, we were rallying and playing sociable tennis with friends.
Believe it or not, about six months after heart surgery I reached the finals in the mixed doubles platform paddle tennis championship tournament at the Bronxville Field Club. Although such strenuous exercise may not be recommended, and I have no plans to resume tournament competition regularly, it seemingly proves dramatically that many sufferers from heart disease must not necessarily be invalids. My heart obviously has mended. Three cheers for the men and women in medical science!
Some months after my operation, the noted British surgeon who performed Britain's only three heart transplants from dead donors said that the recent American technique used on me of grafting a patient's own leg vein into his heart should be applicable to about 90% of persons with heart disease. In the older technique, the mortality risk of the recipient's rejecting another person's heart is very high, and worthy of attempting in only about 10% of the cases where the patient's heart has already been extensively and critically damaged by heart attacks.
