A Medical Economics Web Exclusive

Surgery mended more than my heart

A bypass gave this doctor an unexpected, but not unwelcome, attitude adjustment.

By C. Robert Meloni, MD
Internist/Harrisburg, pA

Ever hear someone complain about having to take three weeks off? I did, three years ago, when my wife, Tracey, suggested we tour Europe and Scandinavia. I was in my 60s and hadn’t been away from work that long in 25 years. I’d become the type of physician who scolds patients for not following treatment plans and lies awake at night mulling over problem cases. Three weeks off seemed unthinkable.

But, finally, I gave in to Tracey’s wishes. To gain enough coverage for the time we’d be away, I took endless nights and weekends of call. Throughout that demanding time, I looked forward to my weekly game of tennis as a way to blow off steam.

One afternoon, as I warmed up, a sudden substernal pain hit me. It subsided when I dropped my arms but recurred when I swung my racket. Feeling wretched and clammy, I sat down. After 20 minutes, the pain subsided. However, I smartly bowed out of the match and–stupidly–drove myself home.

When I told Tracey what had happened, she rushed me to the emergency room. My ECG was unchanged, no enzymes were elevated, and the cardiologist found no new problems. Nevertheless, the results of a precautionary stress test suggested that I should go for an angiogram. That procedure revealed three blocked arteries, and we canceled our vacation.

Ironically, the heart surgeon my cardiologist recommended was on vacation for a month. While waiting for him, I worked part-time, rested as much as possible, and stockpiled some of my blood in case I needed transfusions later.

I’d been told that the surgery would take six hours and would be over by 2 pm. When I awoke, I was still intubated. Although the tube was removed fairly quickly, I still felt liquid dripping down my trachea. Foggy and confused, I asked what time it was. "Two o’clock," I was told. Right on the button, I thought.

Wrong. It was 2 am, the following day. I’d been under anesthesia and experiencing mild hypothermia for more than 20 hours. The bypass had taken longer than expected–one artery had been completely blocked, another obstructed 50 percent–and I’d needed a quadruple instead of the predicted triple. Also, I’d had tremors on the way out of surgery, so I had to be brought along slowly.

For the first two days post-op, rounding surgeons arrived at my bed at different times. They all uttered variations of "you look great, you’ll be fine," before going off to reassure another patient. More revealing were the occasional visits from my employees and colleagues, whose expressions suggested that although I might do fine, I didn’t look so hot. Their visits helped distract me from chest pain that made my "tennis interruptus" pain seem gentle in comparison. Coughing, which I did often, was pure agony.

When I wasn’t bracing against the next stab of pain, I was being helped with everything–washing, brushing my teeth, even using the bathroom. I couldn’t imagine what it must be like for people who for weeks, months, or years remain dependent on others for help in doing what I’d long taken for granted.

I wondered whether I’d ever enjoy the things I used to before my surgery. I was a wiped-out weakling in a hospital gown, with fingers swollen like sausages, a scrotum the size of a grapefruit, and a leg bearing the oozing scar of a vein "harvest." To make matters worse, my mind was swimming with the fears that accompany medical knowledge: What did all this swelling indicate? Congestive heart failure? Renal or liver failure? Why was it so difficult to get out of bed? Didn’t that 85-year-old who came in after me go home already? Why was no one else coughing?

On my fifth day in the hospital, I was paler and weaker. I began to worry that I might slip into unconsciousness, never to see my wife and family again.

But once I started receiving the blood I’d banked, I improved considerably. I was told I could eat whatever I wanted during the healing process–cholesterol be damned–and the tubes were removed. We arranged for home health aides and nurses to help with my recovery, and I was discharged. Once home, I walked the 50 feet from the car to the bed my wife had set up for me on the first floor, where I collapsed.

As I regained my strength, I also realized the surgery had mended more than my heart. For probably the first time in my life, I was grateful for competent, compassionate nursing care. With that appreciation came humility, a quality previously unknown to me. My wife noticed it right away. I thanked her more often for little niceties–such as bringing me something to drink or making a phone call on my behalf–that I used to just expect from her.

Incredibly, by the end of the first week at home, I was walking a mile a day, albeit slowly. After the second week, I was doing 2 miles at a respectable pace. My scars were healing extremely well.

I concentrated all my energy on recovering. Journals piled up, and the office computer I’d brought home prior to my surgery gathered dust. Mostly I thought about the future. Would I be able to go back to work full-time? Would I want to? Could I handle night and weekend call? How many more dinners, football games, anniversaries, concerts, birthdays, family visits, and intimate moments would I want to miss?

I did a lot of soul searching, but in the end, after a month of recovering at home, I went back to work on a reduced schedule–30 to 35 hours a week, with very limited call. Why did I return? For two reasons: I didn’t want the surgery to defeat me; and I longed to share with my employees and patients my experiences and newfound appreciation for life.

When I returned to the office, I no longer tried to solve every problem at every visit. I didn’t get aggravated when I learned Shirley hadn’t lost weight or Tom had failed to check his blood sugars. I stopped getting angry about no-shows, noisy kids in the waiting room, or abrasive personalities. I stopped haranguing about managed care and focused on practicing medicine. And I remembered to thank the nurses.

As much as I enjoyed my work, I realized I wasn’t going to practice forever. The "R" word, which I’d previously never spoken, began to creep into my vocabulary. Fortunately, my kids had left the nest long before, and our finances were in good shape. Nevertheless, I struggled to make up my mind.

Eighteen months after my bypass surgery, still uncertain about retirement, I took six weeks off to travel. We went everywhere, from Singapore to Rome to Washington, DC. Tracey dubbed it our "Around the World in 40 Days" trip, while I secretly considered it our "Can We Stand Retirement?" trip. As it turned out, I enjoyed every minute of the journey, and I never worried about the office.

Three months after we returned home, I closed my practice. In the year since then, I’ve spent a lot of time traveling and writing. In Namibia, in southwestern Africa, Tracey and I discovered and wrote about a wonderful project that provides locals with training in rug-making, and also pays for their housing and medical care. We’ve also worked on a series of online newsletters, covering medical problems from gestational diabetes to thyroid disease.

Writing has proven to be a wonderful second career. More important, it has opened other doors for me. Because I’d never been a writer, I had to give myself permission not only to approach my work differently, but to fail. As every physician knows, that’s not an easy thing to do. But accepting the possibility of failing at new endeavors not only allows me the freedom to try them, it puts the whole world in front of me.

C. Meloni. Surgery mended more than my heart.

Medical Economics

2002;4.