I was lucky: I discovered I needed a double bypass the easy way
(c) Copyright 2023, All Rights Reserved
In June of 2022, a cloudless sunrise found me rowing my sculling shell over glassy Quartermaster Harbor, the inlet that splits Vashon Island, my home near Seattle. As my teammates and I accelerated into a sprint, I felt something like a fist grab my guts just below my ribcage. I gasped and struggled for air, feeling like my lungs had just shrunk to nothing. Bewildered, I slowed down. The fist let go, the pain went away quickly and I could breathe again. The same thing happened on the next sprint. Worried, I took it easy for the rest of the workout.
Soon after getting on my e-Bike to ride home, it happened again. I slowed down and let the electric motor do the work, wondering if I should call 911. It didn’t feel like a dire emergency, but definitely something to check out.
I got into my doctor’s office the next morning. My EKG was perfect, resting heart rate and blood pressure normal, no visible signs of distress. Whatever the problem was, it seemed tied to heart rate, but no need for an airlift and immediate surgery. I was referred to a cardiologist.
When we met two weeks later, Dr. Eva Nicholas quizzed me at length. She ran another perfect EKG, got normal vitals. Puzzled, she ordered several diagnostic procedures. As we parted, I asked if there were any restrictions on my activity. All she said was, “Don’t do anything that hurts.”
So I went home and kept doing what I’d been doing. I hiked in the North Cascades, including a couple of 8,000 foot summits. I went to Grays Harbor to row a touring regatta at the Elk River Wildlife Refuge, one hour at a cruising pace.
Dr. Nicholas’ first order was an echocardiogram. It showed nothing abnormal. Next came a heart monitor the size of a deck of cards glued to my chest. It was intended to record in detail any incident, but over two weeks, nothing happened.
Next up: An angiogram, a project comparable in complexity to surgery. The angiogram uses x-ray technology to produce video of blood flowing through the heart. This massive and complicated equipment requires half a dozen people to operate it and lives in the dungeon of Seattle’s Swedish Hospital. The prep feels like pre-surgery: Shaving hair in various places, IV hookups, the infamous hospital gown and no food.
By the time the procedure wrapped up, I felt dizzy with hunger. I squinted at a video screen as Dr. Nicholas showed me my heart pumping. A dye injected into my heart through a catheter in my wrist revealed blood vessels zigzagging all over my heart like black lightning bolts through a white sky.
“You have a major blockage in your left coronary artery,” she said, pointing at the spot where only the thinnest black line went through to what I later learned is the most important artery in the human heart.
The word “blockage” got my attention. Feeling weak, I asked, “What do we do?”
“Double bypass,” she said, her tone gentle. “If you do this, you will live a long life.”
As she let that sink in, she laid her hand over the crown of my 64-year-old head. I felt her warm reassurance, but still felt queasy. It seemed like a huge decision confronted me. I wanted more information. And I was afraid.
What little I knew about bypass surgery I learned from my father. He had a quadruple bypass at 81. Before his surgery, Dad shared with me his greatest fear: Plaintive, he pantomimed his chest being opened, his arms moving as if he were throwing off a jacket. “It’s an invasion of my privacy! Someone will see inside my chest!”
I worried more about being unzipped from navel to Adam’s apple, a saw down the middle of my sternum, a mechanical spreader bar akin to the Jaws of Life pulling my chest open, and my heart exposed to light. My heart would be stopped. What if it didn’t start up again? And where would “I” be, the me that wears this aging body? Would my soul step out for a breath of air and watch from the ceiling? And if it did, would it want to come back?
Dr. Nicholas referred me to a surgeon but imposed no new restrictions on my activity. That felt strange, so I made adjustments on my own.
My inner Boy Scout made sure my iWatch linked to my iPhone to call for help in case I keeled over. I acquired a hand-held satellite communicator so that if something happened in the mountains, the SOS button would summon the cavalry. As much as I would miss summer on the water, I quit rowing, thinking it might be tough for the EMTs if I had a heart attack out there. One of our members had died exactly that way. The club named a boat after him. I didn’t want a boat named after me.
I also decided to slow down and keep my heart rate under 130.
—
Friends and family responded to the news with shock. Hardly anyone expressed distress. A typical question was, “How could this happen to you?”
Two key reasons: Family history and stress.
My father was a hiker and skier but, like me, had elevated cholesterol his whole life. He had a mild heart attack in his mid-60s and then the bypass at 81. You could say the good news was that he lived to 93.
Then there was stress, and I’d had plenty, complementing the usual stresses of life with the self-imposed kind: Perfectionism, co-dependency, conflict avoidance, and resistance to expressing emotions.
In my early 30s, a career counselor helped me figure out whether to stay in Corporate America. He put me through assessments and interrogations before informing me that Corporate America absolutely did not fit my personality, skills or interests. He also informed me that I was miserable in my marriage and hated living in Dallas; I had unresolved issues with both parents; and I was hyper-competitive, with anger flaring out on all sides and damaging my relationships with co-workers, my then wife and my three children.
At some level I knew all these things but had resisted taking action.
The only reason I hadn’t died of a heart attack yet, he said, was my fitness. “But if you don’t make some big changes, you’ll be dead before you turn 35.”
I took him seriously and by 35 I’d apparently made enough progress to stay alive. I’d left Corporate America, started counseling and spent more time with my children. And we moved to Seattle. When I drove down I-90 from Snoqualmie Pass and saw Seattle and the Olympic Mountains beyond, I felt like I was arriving home.
The stress never went away completely, but I guess I got better at handling it. After two divorces, I fell in love with Shannon 19 years ago and, a few years later, we quit suburbia for the quiet rural enclave of Vashon Island, a ferry ride across Puget Sound from Seattle. Life FEELS less stressful, I’m much healthier overall and I feel much happier than when I’d sat down with that career counselor. Now nearing 65, I could make the case that all the hard work to heed his advice had bought me 30 years.
Dr. Nicholas clearly believed that bypass surgery would buy me another 30.
—
Two weeks after the angiogram, Shannon and I met with Dr. Pat Ryan, chief of the heart surgery team. We took notes as he outlined his plan: Re-route my left mammary artery for one bypass around the blockage, then take a piece of artery from my left arm for the second. In describing the surgery, he used an odd word I thought must be medical jargon: Cabbage. Turns out that’s an acronym: CABG, for Coronary Artery Bypass Graft. He sounded very confident. “You’ll be up walking around the day of surgery,” he said, “and you’ll walk out of here about five days later, pretty much self-sufficient.”
I blurted out my biggest question: “What about stopping my heart?”
“Standard operating procedure for more than 50 years,” he said. “We do 800 of these a year.”
We signed up for surgery five weeks later, two days before my 65th birthday. I asked Dr. Ryan if there were any restrictions on my activity: “Don’t do anything that hurts.”
Four days later, I went to Hurricane Ridge, my favorite spot in Olympic National Park. Satcom in hand, staying on the busiest trail, taking short, slow steps on the steep parts, and watching my heart rate, I noticed something: Slowing down allowed me to take in everything Nature offered me. I touched the bark and needles of Sub-Alpine Fir, puzzling over crystalized sap that sparkled in the treetops. I watched the drying grasses move in the breeze and searched for color among the desiccated clumps of wildflowers. My typical compulsion to get to the top was absent. I allowed myself to stop and to take in the wide sweep of the Olympic range’s snow-capped peaks. I spotted an unoccupied bench, perfectly positioned, so I sat. I ate my lunch, drank my water. My eyes traced the jagged skyline of glaciated peaks and snow-dappled ridges, searched the dark forested depths of wild river valleys for glimpses of water or trail.
A butterfly came along. It landed on my chest. Right over my heart. Wings flexed, tiny antennae quivered. It hopped to my left arm. A minute later, it flitted away.
I raised my face to the sun, soaked in the warmth, felt the light breeze. I walked back to my car feeling joy. I wondered if I really needed to do this surgery. Could I enjoy life within my self-imposed limit of a maximum heart rate of 130?
A short life, perhaps: My blockage wasn’t going away, and that tiny sliver of an opening in the most important artery in my heart could close at any time.
I knew I had to do it, but two weeks before surgery, I felt a surge of fear: They’re going to cut me open. Stop my heart. I could die. This wasn’t rational. I’d done the math: Dr. Ryan gave me 99.3% odds for a good outcome. Eight hundred operations per year over 30 years seemed like a pretty good data set on which to base that prediction. Refuse surgery because there was a 0.7% chance I would die? Ridiculous. Do nothing and become one of the thousand Americans who drop dead every day of cardiac arrest? Insane. Or do the surgery and almost certainly buy another 30 years? Hard to imagine a better deal.
Still: The scalpel. The saw. My heart stopped, then repaired with sharp tools under bright lights.
I visited a rowing teammate, Mark Burns, himself a heart patient. He poured me a beer and listened. With my quandary spoken out loud, he said, “Cardiovascular disease presents in one of three ways, about a third a third a third. One is angina, chest pain like yours. Another is a major heart attack that leaves the heart permanently damaged. The third is cardiac arrest and death.”
“Oh,” I said. “I guess that makes me one of the lucky ones.”
He smiled.
“That means I GET to have open heart surgery.”
“You’re going to do great.”
—
Very early the day of surgery – check-in 5 am – I pulled on my faded lucky tee-shirt: The Hurley logo tee my son Andrew had given me as a birthday gift 21 years earlier. Shannon drove me to the hospital’s main entrance. We kissed good-bye at the door. I checked in, got my hospital wrist-band, and walked into the prep area. With blood pressure normal, heart rate normal and feeling calm, I declined a sedative. Over the next hour, a nurse sheared the hair off most of my torso, left arm, inner thighs and calves. She installed a couple of IV hookups in my right arm and wrist.
Dr. Ryan, the surgeon, dropped in to say good morning. “Are you ready?”
“Whenever you are.”
“Great!” We fist-bumped. “You’ve got a ticket to ride!”
Next came the anesthesiologist. Time to go. He wheeled me down an elevator and through hallways into the surgical theatre, all bright white lights, stainless steel and glass. I looked around, fascinated. There sat the heart-lung machine, looking like three family-sized refrigerators. The room felt cool. He invited me to climb onto the operating table with the relaxed demeanor of a familiar maître d’.
I felt completely serene.
I woke up in ICU five hours later.
—
The next time I saw Dr. Ryan, I asked him what it was like to hold a person’s living heart in your hands.
“I try really hard not to think about it too much,” he said with a small smile. “If I were going to try to describe this job to someone, well, I cut their breastbone open, we pop their chest apart, we run a bunch of big tubes in their heart and run (their blood) through a machine and then we stop the heart, then we do some sewing and put it back together again and figure it’s going to work. That’s like the weirdest job in the world. So if you thought about it, this massive controlled violence, you’d be so terrified you’d never do it.”
Dr. Ryan’s controlled violence left me with new plumbing on my heart plus two long bandages covering the incisions on my left forearm and chest. I also had wires and drain tubes coming out of a tidy little hole just above my navel, EKG leads all over my torso, a catheter in my urethra, one set of IVs in my right arm and another on the right side of my neck. Thanks to the pain meds, I felt only a mild burning sensation along the incisions and across the bottom of my rib cage. The muscles and tendons on the front of my neck felt sore, as if I’d been whiplashed.
At 1 am I woke up overheated, one arm pinned by a tangle of sheets, blankets, wires, tubes, drains and sensors. The sticky oxygen sensor on my other hand kept my fingertips just inches away from the nurse call button. I lunged but fell just short, scared and embarrassed that I might actually have to call for help, worried I’d wake other patients. I reached once more but couldn’t get there. Tears in my eyes, I finally shouted, “Brian!”
And he appeared.
He gently helped me sit up. He unwound the tangles and removed what I didn’t need anymore. “You’re doing great,” he said.
Barely 72 hours after checking in, I was released. I felt thrilled as an orderly wheeled me downstairs. As we approached the main entrance, I looked out into the hospital’s sunny circle driveway and suddenly clutched the red heart-shaped pillow I’d been given. I didn’t want to go. For three days, I’d been protected by caring nurses in a safe environment. Now, sternum wired together and chest freshly stitched, weakened by medications and sleep-deprived, I was being thrown back into harsh reality. I felt vulnerable and small.
But Shannon was there waiting for me. I climbed into the back seat and put that pillow between my chest and the seat belt, as ordered. I hugged myself for protection, but every bump in the road hurt. I felt a huge sense of relief to get home and fall into bed. Our cat Carina promptly installed herself on my lap.
Looking forward, each milestone in my recovery seemed impossibly far away. Looking backward, the days flew. I walked every day, at first less than a mile, building to seven miles over five weeks. The first time I swam, I had to stop every two lengths and went straight home and fell into bed, completely shattered. Five weeks later, I could go 20 lengths without stopping, leaving the pool feeling full of life. The hardest part? For the first three weeks, my orders included limiting arm movements by keeping my elbows tucked into my hips. I felt like a robot with a gag order: How is this Italian supposed to talk without moving his arms around?
Three months after surgery, I graduated from the hospital’s Cardio Rehab program with no restrictions. Rowing was still four to six weeks away, but I didn’t mind. I knew I’d get there. Besides, it was winter.
To celebrate, I went back to Hurricane Ridge for some snowshoeing. I arrived on a windless blue-sky day among snow-covered mountains. Rather than focus on speed and reaching summits, I mostly just stumped around in the deep fresh powder. Rather than power past with hardly a glance, I paused to admire wind-sculpted cornices, snow drifts, and stubby fir trees shaped into abominable snow creatures. As the day warmed, I heard the thumps of snow clumps falling off trees. I pondered the fates of snowshoe hares who had left perfectly spaced tracks in the powder.
As I snowshoed along a treeless ridge, I came across the edge of a picnic table buried in snow. I sat before yet another sunny panorama. I smiled for a selfie.
A few minutes later, I realized I was still smiling.
affected the outcome.
y-arrived “Anglo-Americani,” they marveled at the Maori’s tattoos.
The mountains called us today, to Harts Pass. Making that drive brings out the cowpoke in me. As many times as I’ve made that trip, I still git nervous when that old washboard forest road gives way to a rocky track blasted from a cliff face named Dead Horse Point. Heck, two years ago, I run into a rock slide and had to turn around. No mean feat, made a 17-point turn, my back end hanging over the edge. You fall, you die. Snow, same thing, I’ve done it a thousand times and got stuck then unstuck a couple, but I still worry. This time, to git up that last quarter mile, to the pass, I had to drop the old Land Cruiser into low range with both differentials locked. That snow was heavy as concrete and them wheel ruts was so deep my undercarriage, as high as it is, plowed snow up the middle. The old rig started slippin’. I got her stopped and a glance in the rearview told me what I already knew: 400 yards in reverse down a slippery slope to the nearest turnaround. Maybe if I back up a little, then run at it again. So I dropped it into reverse, just six feet or so. I moved into neutral, fingers drumming on the shifter. Give it a couple of tries, see if it’ll go. Hope I don’t high center. OK, into drive. Tap the gas. A little more. I felt a little oof as the tires pushed through the clogged up rut. A bounce right. A bounce left. But still movin, still movin and then…made it!
Jessie promptly buried herself in the snow. I strapped on my snowshoes and we hiked a mile and a half up to the Pacific Crest Trail junction. No broad vistas, what with clouds and snow flurries, but beautiful and soothing still.
On our way, a big pickup truck hauling a very long livestock trailer pulled up and just stopped in the middle of the adjacent road. A couple jumped out, swung the trailer gate open and led off two saddled horses. We exchanged friendly hellos as they mounted up and explained themselves: They were after some runaway cattle. “We gotta get’em quick, they won’t hang around,” he said, and they galloped off in pursuit of four cows lounging in a nearby aspen grove.
