After Covering Sophisticated Surgery, He's the Patient : Veteran Correspondent Writes a Story That's Straight From the Heart

Associated Press

People most associate valve jobs with cars, a way to keep the old crate running a few more miles. I've had two valve jobs. Not on my car, on my heart. Two. In four months.

I had little choice. My engine was starting to fizzle, and the solution was a valve replacement if I wanted a shot at old age.

So I went from writing about cardiac patients as a reporter to being one. A somewhat special one at that.

Among heart patients, bypass surgery has become almost commonplace in America, about 180,000 such operations a year. Valve jobs are considerably rarer. An estimated 39,500 people had them in 1986, the year of my first operation. I will also be included in the 1987 statistics when they are compiled.

Nobody keeps track of how many Americans make the valve-repair list two years in a row. Not many, of course, but I would gladly have declined the honor.

No Complications

My first operation, on Oct. 7, 1986, should have been the start and end of the story: surgery, recuperation, rehabilitation, get on with life. Indeed, there were no immediate complications.

But what started as a relatively uncomplicated trip along a straight road detoured into a tortuous journey down a twisting trail full of potholes. I seemed to hit nearly every one.

Along the way, over the next 4 1/2 months, I:

- Sprang a leak around my replaced valve, tissue tear causing premature destruction of my red blood cells;

- Underwent a second surgery to fix the tear, and to repair a second faulty valve;

- Potentially faced yet another operation because of a possible infection for which I received antibiotic treatment;

- Suffered an allergic reaction to the antibiotic and had to be rushed back to the hospital, and I developed phlebitis.

As if that weren't enough, 14 days before my second open-heart surgery, I had to put my dog Montrose to sleep. My constant friend of 11 1/2 years, part Airedale and the rest only God knows what, suddenly took ill of a previously undiagnosed cancer. I remember tearfully saying to him, as he lay at the vet's office, "We hit all the odds, buddy."

We sure did.

For half a year, I was strapped into an emotional and physical roller coaster, riding the downs and ups of surgery, rehabilitation, surgery, rehabilitation. During that time, I gained a fairly extensive insight into the life of an invalid.

I also picked up a firsthand understanding about coping with life's uncertainties. The irony for me, a reporter, was that I was my own subject. Those peaks and valleys were mine.

In the first weeks after my initial surgery there were many days when I felt worse, not better; when I was short-tempered, had no strength, no appetite, became angry if people told me how well I looked and sounded--because I certainly didn't feel that way. My chest, which had been cut and cracked open, ached. Sleep was difficult. I seemed to become a crusty ogre.

But there also were times when I definitely felt better, more frequently after I started in a rehabilitation program about a month after surgery.

That involved wearing a heart monitor, walking on a treadmill, riding a stationary bike, doing arm and stretching exercises and, after a time, lifting light weights. The regimen was satisfying and motivating.

The program also included nutritional counseling and heart-related lectures, equally valuable. Stress management training also proved most beneficial.

Longer Than Expected

Even so, my recovery took longer than I had anticipated. I had interpreted the doctors' optimism about the surgery to mean that within a month or so I would be running around as before. When four, then five, weeks passed and I still didn't feel that way, I became anxious and irritated.

One reason it took longer than expected was because of what the doctors would not discover until January.

The tissue anchoring my new mechanical aortic valve was proving to be about as strong as Kleenex. Two sutures had torn in separate portions of it. My mitral valve also was leaking.

Like any other pump, the heart has an inflow valve and an outflow valve. They control the flow of blood into and out of the left ventricle, the chamber where the blood is purified and sent back into the body. The mitral is the inflow valve, the aortic the outflow. They work in unison; when one closes, the other opens.

The leakage around the aortic valve wasn't as severe as what had necessitated my surgery, but the potential consequences were dramatic. I had just returned to work and was resuming a somewhat normal existence as a husband, father and provider, only to learn that I would be back on the table again on Feb. 16, four months and a week after my first operation.

The surgeon learned, on going back in, that my mitral leak was significant. Its severity either had been masked previously by the massive aortic leak or had developed only after the first operation.

How had all this come about?

In the summer of 1986, I was a slightly overweight 40-year-old reporter who studiously avoided anything more strenuous than pushing away from the dinner table or running for a telephone on a breaking news story.

As the Associated Press correspondent in Tucson for six years, I had covered numerous developments in heart surgery.

They included heart transplants performed by Dr. Jack G. Copeland and his cardiothoracic team at the University of Arizona Medical Center and Dr. Edward B. Diethrich's first live public telecast of a cardiac bypass operation in Phoenix.

They also included Copeland's controversial 1985 implantation of an experimental artificial heart and his use later that year of a Jarvik-7 plastic-and-metal pump as the first successful bridge to heart transplantation.

Finally, I had covered much of the saga of Bernadette Chayrez, the first person to receive two artificial hearts, also at UMC.

So it was a curious turnaround to find myself a patient of Copeland's.

I had known for 18 years that someday I would need my aortic valve replaced. On July 30, 1986, after my latest echo-cardiogram, my cardiologist told me that that someday had arrived.

We scheduled my surgery for Oct. 7.

Waited 18 Years

Why did I wait 18 years for surgery? Both artificial and animal tissue valve replacements have their problems. Mechanical valves run the risk of blood clot formation that must be countered with a blood thinner. Tissue valves can wear out in seven to 15 years.

So my doctors felt that so long as I functioned fairly normally without dramatic change in heart size, it was preferable to postpone surgery. An artificial heart valve does carry limitations: no mountain climbing, no weight lifting, no tackle football. I can live without them.

Having seven weeks to think about the operation, largely to bank my blood, brought me to stark confrontation with my own mortality, something that I consciously had skirted in the 18-year interlude.

I noticed more attentively as the Fridays, Saturdays, Sundays and Mondays came and went; I tried to spend more, and better, time with my wife Debby and daughter Becky.

I looked a bit more closely at the mountains and the desert's beauty.

What had brought me to that cold and impersonal table were subtle, silent changes that had occurred inside my chest over nearly two decades. My progressively enlarging leak, called an aortic insufficiency, had left me with a heart twice the normal size, comparable to a squishy sponge, like a Nerf football kids play with.

A cardiologist in suburban Chicago had diagnosed my condition in 1968 after detecting a heart murmur.

I tired more easily with physical exertion, but otherwise felt fine.

A significant increase in the size of my ventricle that had moved me into a danger zone forced the decision to operate.

As my operation neared, my doctor said I would weather the surgery well because I was about 25 years younger than the typical cardiac patient, generally in good health and didn't smoke.

They were right. The operation went like clockwork. Within a little more than two hours, Copeland and his team had opened my chest, replaced the defective valve with a large pyrolitic carbon St. Jude mechanical valve and closed me up again.

When I awoke I found myself with a 9 1/2-inch scar in the middle of my suddenly hairless chest, a lot of aches, no stamina and 23 pounds lighter.

I learned later that when my heart rate increased from about 80 to 160, the doctor gave me a paralyzing agent to calm me down.

It worked. I remembered nothing from Monday night until early Wednesday morning, the day after my operation. My first conscious sensations were of something in my throat that prevented my speaking, of hearing voices saying the breathing tube would be removed in about six hours, and of wondering why I had one in my throat before the operation.

That's when I realized I must have made it.

No Recollection

I have no recollection of talking with Debby before the operation on Tuesday, or of Copeland telling me late that afternoon that I had come through fine, and my blinking and squeezing his hand in acknowledgment. The body and mind, it seems, play tricks on surgery patients.

I was in the cardiac intensive care unit for two days and went home a week after the operation. Copeland had visited me practically daily, except when, four days after my operation, Chayrez died while receiving a second human donor heart.

My daughter, then 10, told me that with my new valve, which makes an audible click, I sounded like the crocodile in "Peter Pan." When it's quiet, I frequently hear myself ticking. In time, the noise has become a comforting assurance.

Slowly, the realities of recovering from cardiac surgery sank in. I had made it. If I didn't exactly dance in the rain I took to singing in the shower--once I could get in it, as my incision (which reminded me of a stuffed Thanksgiving turkey) began to heal.

I had no overt symptoms on Jan. 5 when Copeland, stethoscope glued to my chest, listened intently during a checkup, trying to decipher a murmur-type sound that had been troubling him and my cardiologist.

Saying that he was "a hands man," Copeland had the university's chief of cardiology listen to me. He explained that his colleague, Dr. Gordon Ewy, had "the best ears around here." Ewy confirmed Copeland's fears. The diagnosis: aortic insufficiency, a leaky valve. For the second time.

Clearly upset, Copeland looked at me and said, slowly, "I'm sorry . . . I think we're going to have to go back in again."

In the car, I fell to swearing. I asked the inevitable, unanswerable question: "Why me?"

It would mean another round of pain and discomfort, of sleeping only on my back for a month, of stifling every cough and sneeze, of having to rebuild my strength from scratch for the second time in four months.

Copeland at first thought it would be best to follow the situation closely and reevaluate it in nine months or so. But then blood tests showed that the leak around the edge of the artificial valve was chewing up my red blood cells and he changed his mind.

Strangely, as my second O-Day approached, my apprehensions diminished. I became serene. I also had fewer expectations about the speed of my recovery.

On the morning of my surgery, Copeland came in to tell me the operation would have to be postponed because a heart transplant was to be performed. I accepted the personal news with disappointment and had Debby call the Associated Press in Phoenix about the national news, the transplant.

Transplant Washed Out

Later in the morning the transplant had washed out and I was rescheduled for 1 p.m.

My surgery was prolonged somewhat because Copeland had to work his way through growth of scar tissue before he closed the leaks around my prosthetic valve. Then he repaired the mitral valve.

At first, I showed a dramatic post-operative improvement. I ate some solid food that night. The next morning, I walked, by myself, from intensive care to the cardiac monitoring unit.

But a culture the doctors had taken suggested a contaminant on my valve. I was put on a powerful antibiotic. An infection would have meant yet another valve replacement. "I'll be eternally grateful if it's not," Copeland said. It proved not to be.

All in all, I was making progress.

On the ninth day after my operation, I had a temperature of 100.6, but it was gone the next morning.

Copeland listened to my heart and told Debby, "I think he's good for another 100,000 miles," and sent us home. Three hours later, I had a temperature of 102.

Back to the emergency room.

I hadn't been out of the hospital long enough for them to change my sheets. My roommate welcomed me back warmly. He was awaiting a heart transplant.

I remained another five days.

They found that an allergic reaction to my intravenous antibiotic had caused the fever and switched to an oral medication, which I stayed on for three more weeks.

This time, my frustration level seemed lower. I bided my time. In late March, I went back to my rehab program, and a month after that, to work.

Now I'm back in the news business, writing about everything from immigration and court cases to football games and medicine.

And heart operations.

On those, occasionally I run into Copeland. He's more than just another news source to me now. And I must admit I feel a little added affinity for his patients.

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