The Surgery

At 4:00 pm on September 15, 2005, I didn’t wake up.  This was a problem, and then it got worse. 

The day before, I had briskly walked two miles to my local hospital in Colorado, where I was to undergo an angiogram to view the arteries in my heart.  The procedure was recommended because I had received a dangerously high score on a CT scan a day earlier, which placed me in the 95 percent percentile to have a heart attack with a decade.   I had requested the CT scan at the request of my son, David, who was concerned about my poor family history with heart disease.  My father and grandfather had both died young of sudden heart attacks, my grandfather at 46.  Despite the worrisome CT score, I had no real symptoms of any heart problems.  I had to talk a cardiologist into prescribing the scan because my results on the Framingham test, used to screen for heart attack risk factors, initially placed my odds of a heart attack at only 2 percent. 

During the angiogram, doctors inserted a tube into an incision into the femoral artery in my inner thigh and maneuvered it through my body and eventually into my heart.  Dye was injected through the tube, lighting up my arteries for pictures similar to an x-ray.  The pictures revealed major blockages, up to 90 percent, at several points in my heart, including in the left anterior descending (LAD) coronary artery, known as “the widow-maker.”  I was told I needed a quadruple coronary artery bypass graft (CABG, pronounced like “cabbage”) as soon as possible.  I was urged not to go home.

In preparation for open-heart surgery, my entire body from my neck down was shaved.  A nurse scanned my body with a handheld device similar to what the power company uses to locate utility lines beneath back yards.  Following the beeps, she sketched the arteries and veins throughout my body on my skin in black ink.  In the end, I looked like a skeleton man ready to go treat-or-treating, although I was naked. 

Next, my wedding band, on my hand for 28 years, was removed, instilling my first real fear.  Early on the 15th, IVs were inserted, drugs administered and a battery of monitors attached.  When the surgeons were ready, I kissed my wife, Cheri, and we professed our love.  I watched her as I was wheeled to surgery until the doors to her closed.

The lights in the operating room were bright, the movements of the five-person surgical team quick and confident; their eyes focused, their voices steady.  As a nurse began to strap down my arms, she asked the anesthesiologist, “Is it running?”  He said “yes.”  “It” must have been the anesthetic. “Yes” was the last word I heard as the person I had been for 56 years.

I had been put under around 10:00 am and was scheduled for a six-hour surgery.  First they cut a 10-inch incision in my chest, from below my neck to above my diaphragm.  The skin was pulled back and a power saw cut through my breastbone.  My chest cavity was pried apart using a device similar to a scissor car jack.  As a circular crank was turned, the two halves of the jack slowly spread my chest apart, exposing the pericardial sac, which, when cut, revealed my beating heart. 

Major arteries and veins to and from my heart were punctured and tubes from a heart-lung machine were inserted.  The blood flow was then shunted around my heart and lungs, oxygenated by the machine and circulated throughout my body.  Cold blood was injected into my heart, which stopped the beating.  A heart should be stilled during a CABG less than one hour in order to prevent brain injury or death.

In the meantime, other doctors were working on my legs to extract sections of veins to be grafted into my heart before and after the blood vessels blocked by plaque.  They made six cuts in my legs from which they harvested strings of blood vessels.  They also worked on my upper chest, where they exposed two mammary arteries to serve as additional heart grafts.  From this supply of replacement parts, four grafts into my heart’s plumbing system were completed.  

A moment of truth occurs when warm blood is injected into the heart and the heart-lung machine is turned off.  Will the heart jump start to beat again on its own?  If that doesn’t happen, there are a couple of tricks doctors can perform, including applying electroshock paddles.  If nothing works, you’re dead.  One to two percent of open heart surgeries end this way. 

A second showstopper is how much crud in the heart gets swept up in the first flow of blood when your heart restarts.  It’s like an oil change in a car.  The new oil is clean, but it picks up gunk from the engine walls when it is restarted.  In rare cases, trapped gunk can destroy an engine.  In the case of a heart, the loosened plaque eventually reaches the brain, where it causes small strokes.  A typical open-heart surgery causes eight to 12 mini-strokes in the brain during restart.  They contribute to the temporary short-term memory losses and confusion that plague open-heart surgery survivors, one of several common “post-pump” symptoms.  More severe strokes cause lasting dementia problems.  Victims are often called “pumpheads” by ICU nurses.  The best walk around a little dazed, but otherwise normal.  The worst are institutionalized.  The lucky ones die.

My heart once again beating, the rest of me was put back together by a reverse process.  The chest cavity was eased back into place by reversing the crank, the halves of the breastbone were bound with wire and the incision was closed with stitches.  I was wheeled into the ICU adjacent to the surgery theater around 4:00 pm and weaned from the anesthetic. 

But I didn’t wake up.  I lay in the ICU until close to midnight, a number of white-coated doctors hovering around me.  Cheri was with me most of the time and forced to watch me struggle to stay alive.  At 9:00 pm, my ICU night shift nurse, John, came on duty and joined in.  About 10 pm, the doctors thought I had stabilized enough to be handed over to the nursing staff for the night.  For Cheri, it had been a harrowing 18 hours.  She went home, took a sleeping pill and went to bed.

Shortly after she left, my heart stopped beating.  It simply quit.  The doctors later deduced that one of the heart grafts didn’t hold properly and was slowly leaking blood into my chest cavity.  This created pressure against the heart, making it increasingly difficult for it to beat.  My heart, already stressed by the surgery, gradually tired.  Leaking blood into the pericardial sac is called cardiac tamponade.  Two out of 10,000 people ever experience it.  If untreated, it is fatal.

Alarms on the machines hooked up to me in the ICU came alive.  John jumped on my bed and initiated CPR, while others rushed in with the “crash cart”.  My heart beat was revived by electroshock in “less than a minute,” according to several accounts from doctors and nurses the next day.  Current medical wisdom, or perhaps the advice of liability attorneys, holds that being dead for less than a minute does not result in brain damage, and they wanted me to know I was all clear.  They turned out to be wrong, but it was comforting to believe at the time.

John called Cheri, who was just drifting off to sleep, and told her the situation.  She returned quickly to the hospital.  I had already died once that day.  The next time might just kill me.

The doctors in the ICU decided that my heart cavity should be reopened to fix the probable leaking graft.  The same five-person surgical team was awakened at their homes and asked to return to the hospital.  Bleary eyed or not, they reassembled, and I was again wheeled into the operating room for a second multi-hour open-heart surgery.  The stitches and wire were cut and my chest cavity reopened to reveal accumulating blood surrounding my heart.  The surgery team drained the pool of blood, sutured the leaking artery, and rezipped my breastbone and chest. 

I was shipped back to the ICU sometime well before dawn on September 16, where I gradually came to, alone, in a room completely dark except for the small lights on a bank of beeping and gasping machines surrounding me.  I remained in a state between life and death for several hours.  There was no conscious pain, only a sense of deep hurt.  I didn’t know where I was or even who I was, but I knew I was hurt to my core. 

I could hear my own breath in the darkness.  It was, in fact, the only sound I could identify, and I began to listen intently.  As each breath began to fade and the sound dwindled toward silence, I wondered if there would be another.  I knew I was just about dead.  There was no past, no future, no time.  Only each breath, one following, against all odds, the other.  I knew each breath could easily be my last.  I was at peace with this thought.  All fear of death had died with the end of time. 

Many other thoughts as I lay dying were oddly mathematical.  One of my very few memories was a teacher walking into my 7th grade math class to announce that I had won a school-wide math competition and would receive a “new” math book as a prize.  It was my only memory.

I began wondering how dead I actually was.  I guessed about 98 percent.  Whatever it was exactly, it was certainly a long drop from 100 percent alive the day before.  The face of a large clock on a wall in front of me indicated that it was 4:00.  I remembered that my operation had started about 10:00 am and was expected to last six hours.  I concluded that 4:00 was good news.  The math seemed to be saying I was right on schedule. 

I felt restraints on my wrists, which upset me.  John appeared at my bedside moments later and gently untied them, creating a bond between us.  He sat by me, placed his mouth close to my ear and whispered that I had had open-heart surgery, my heart had stopped beating, I had been brought back to life and had undergone a second open-heart surgery.  It wasn’t 4:00 pm, my expected wake up time, he said, but 4:00 am the following day.  He left and I tried to process this new information. 

Math interrupted again and grew more complex.  The assessment of being 98 percent dead was gaining credibility, but now the vectors had changed.  Instead of viewing this as a loss of 98 percent of life, I now saw it as a two percent improvement from death.  So I was actually already recovering and had regained a small portion of life. 

With this fact now apparent, my comforting drift into death was confronted, rather rudely, by serious ruminations about my prospects for survival.   These thoughts were overcome by a wave of terror.  I realized that I would be letting the easy way of dying slip through my fingers if I survived.  I had quietly gone to sleep in the operating room the day before, after hearing a life affirming “yes.”  If I survived now, I would have to die again, perhaps in a horrible car crash, perhaps in dreadful pain from cancer.  Dying the next time might not be as easy or painless.

A few moments earlier, death had seemed like a pain-free escape for me, but now I realized it included the loss of my family.  I felt unbounded love for Cheri and David.  The thought of leaving them was unbearable.  Dying was no longer an option.  Fighting death became my mission, although my fear of dying a second time haunts me today as it grows inevitably nearer.

Mathematics again entered my world.  The number 56, my age, appeared before me in a sentence, “56 isn’t right.”  I have no idea where this sentence came from, but it was not from within me.  It was loud and clear, stated confidently, and I instantaneously accepted it as true.  Stunned by this revelation, I gathered my strength and asked whatever force spoke to me, “then what is the right number?”  There was no response.  I tried a second and a third time.  I knew getting an answer would be extraordinary, but there was no response, then or since.

I was worried about Cheri.  I would not have persevered through the long surgeries without her being close by.  It was not a coincidence that I died only when she left.  We were soon reunited joyously, along with a bevy of white-coated doctors once again gathering around my bed.  This time I was awake.  The doctors eventually exhausted their list of questions and gradually drifted away.  I guess the excitement for them was over.  John and Cheri began bustling around my room setting me up for the day. 

I glanced at the clock for the first time since 4:00 am.  It said 6:02.  I stared at it for a long time.  The minute hand didn’t move.  I stared longer and after a very long time, I blurted out irritably, “the clock doesn’t work.”  John came over to me and whispered that the clock was working fine.  I stared some more.  Finally, there was an earth-shattering click and the minute hand leapt aggressively, boldly and violently from 6:02 to 6:03.  I had rejoined the world of the living.