Minor glitch

Things had been going very well, although a couple of weeks ago, I felt like I overdid things. My heart rate went up and became irregular. I thought I might be in atrial fibrillation, having had that in 1990 when I had endocarditis, although this irregularity was not as bad as it had been then. I thought of calling my doctor, although I wasn't too worried. I am aware that there is some stroke risk, however, I am on coumadin, so I knew I was protected from that possibility. By the weekend, my heart beat seemed to resolve, although I did take note that it still was fast. This was not something I could tell by myself, but when I took my pulse, it was clearly holding at 120 beats per minute. So, I called my cardiologist and was told to come in.

Dr. Ginzburg was on vacation, but I saw one of his partners who told me I was having atrial flutter. He changed my atenolol to metaprolol, and told me to come back the next day. I saw a different cardiologist, who ordered an echocardiogram, but otherwise did not seem alarmed. By the end of the week, they called Dr. Ginzburg (apparently on the golf course). He upped the medication further, and said he would see me the next week. I saw him on Friday and, after two weeks of an unrelenting flutter, he decided it was time for cardioversion (shocking my heart back to a regular beat).

This does not lead to pleasant thoughts. But, I did what he ordered and, on Monday, had a combination transesphoghial echocardiogram and cardioversion. I felt like I was on death row, as the nurse attached the electrodes to my chest and back. They assured me I would be sedated. They did the TEE first, to make sure there were no blood clots, which might get dislodged when I was shocked. I remember the tube going down my throat. From that point on, everything goes blank.

The procedure worked and, whatever they gave me, it was not your ordinary anesthetic. It wiped out my memory. Not only don't I recall getting shocked, I don't recall leaving the hospital and riding home. Everything is a blur. Even though I went to work the next day, I felt in a fog.

Anyway, it was a good thing they did what they did. This morning, when I got up, I could truly feel the difference. My heart is beating about 60 times a minute. It is completely steady (which it has not been in a long time). I feel very good, to the point that I think, I'm almost normal again. So, a minor glitch. Otherwise, everything seems to be going very well.

Update

It's over a week since my last post, and 16 days after the operation. Last week, I went into the office to see one patient, someone I was particularly concerned about. I won't start seeing people regularly until Aug 3, my original plan. At the time, I said I would be working part-time until Labor Day, but at this point, I'm not sure why. Yesterday, something clicked. I had been getting better in a gradual way since being discharged from the hospital, but yesterday, I felt a strikingly new level of energy. I had an appointment with an orthopaedic surgeon, to deal with a nagging problem I have with my left shoulder, but have delayed doing anything about until after my heart surgery. He referred me for PT, but delayed on either anti-inflammatory medication (since I'm on Coumadin right now), or an injection (which he did not think I should have, due to my recent surgery). Afterward, Maryka and I spent the day at home, reading and playing Scrabble, before we went to Chili's for dinner. The thing that caught my attention, the click I referred to above, is that I felt perfectly normal. Today, I woke up and realized that, except for some minor issues -- not yet allowed to drive, cautious about lifting anything heavy, waiting to play tennis again -- I feel almost fully recovered. I think, if I needed to, I could return to work next week, not part-time, but full-time. It's really hard for me to see why I can't resume a completely normal life, right now. I will take care. After all, I had open heart surgery just two weeks ago. Still, it does not feel as if I did.

Finally home

It's Wednesday, July 15, 9:27 am. Seven days ago, I was lying on a table, anesthetized, as Dr. Rosenbloom and his team did their surgical magic. I've been home for the last three days, and am about to publish my last (at least for a while) and probably most bizarre post: the story of what has happened since I got home.

Following some last minute scares, my EKG in the middle of the night, and an early morning blood test of my Coumadin level(the nurses had overlooked the order, so I had to wait for those results to come in), Drs. Ginsburg, Bowen, and South Africa came to my room to tell me I was going home. Maryka commented on how well I was recovering, and Dr. Ginsburg responded, as he had the day before, that Dr. Rosenbloom and his team do a very good job. This time, after a pause, he gave credit to the healing powers of the patient.

After getting my discharge instructions, we left the hospital and stopped at CVS, where Matt and I filled my prescriptions, while Maryka bought lox and bagels for my first not-Heart-Healthy meal in days. I got home where BB, who had not come to the hospital, gave me a hug. I saw Sasha, who had driven in the night before, and had visited me briefly in the hospital as well. We all played some games of rummy before Sasha and Matt had to leave. Since then, Maryka and I have enjoyed our time together. We'll see my mother today. She is coming over for lunch. On Saturday, I am hoping to drop by the tennis court and say hello to the members of my tennis group (no actual play for a few months). Matt thought I should dress in tennis wear, and walk to the court carrying my racquet. I'll visit my mother on Saturday, following our routine of breakfast in her apartment, every Saturday morning. Sunday, I plan to go to church. Next Monday, I hope to start completing some reports (there were ten I could not get to before my surgical break). Now, here's what is bizarre. This whole operation feels like no big deal. When Dr. Rosenbloom first told me he could not do minimally invasive surgery because he would be working on two valves, I asked if it would be better to do two separate operations. He responded by asking if I knew anyone who had had heart surgery, the implication that you don't want to do this twice. Now, I think his response should have been, Why? I'll have you out in a jiffy.

I feel quite well. Just one week after the operation, I have very few problems. The numbness in my right hand persists. I can't lift anything heavy (when we went to LabCorp yesterday for my blood work, Maryka opened the somewhat heavy door for me). I get a bit more tired doing ordinary things (yesterday, I walked from the bedroom to the dining room, but kept forgetting things I needed -- the back and forth trips a bit wearing). I'm not supposed to drive. All that notwithstanding, I feel good. In fact, I have no doubt that, if I had to, I could return to work today. My plan is to go back on August 3, and work two hours a day. I could do that now. I'm not going to. I'm sticking to my plan. But, that's still the truth.

Before my operation, I talked to others, Tom Leacock, who had previously had heart valve surgery at a much younger age, as well as Howard. I conferred with my doctors to see what to expect. Dale Matthews, a doctor and Maryka's nephew, has always been helpful with information and advice. I bought a book, "The Patient's Guide to Heart Valve Surgery," written by a former double valve replacement patient. Nothing I learned could have possibly predicted the response I have had.

Note, I said bought, not read, The Patient's Guide. It was an ominous book, which I put down quickly. It predicted serious pain, risk of opiate addiction, and months of a slow and difficult recovery. The author advised setting up a "support team" for 24 hour care when you return from the hospital. You will need a bell to summon help, as it will be too painful pulling yourself out of bed. It took him three months to return to work. One week? Inconceivable!

I feel good. I feel better today than I did at this juncture when I went to the hospital in February. Then, I was drained. Dale and Demetra dropped by that Sunday. I enjoyed their short visit, but had to go to bed before they left.

Although I may update this blog, as things transpire, this will be my last regular post. I have other things to do. I will still stay home until August 3, but there is some other writing I have wanted to do, but never have had the time. So rather than post to this blog (unless something significant comes up), I'll put my writing time into that project instead. For all who have followed, thank you for your interest and support. It has certainly helped to know there are people who care.

My new room

On Friday, I was transferred from the ICU to the cardiac ward. Cooper wants to be the premiere heart (and general medical) facility in the Philadelphia area, a daunting task given the other fine hospitals around. They built a modern, new wing where my surgery took place and where the ICU is located. They still use their older building, so my transfer involved an elevator ride down to the basement, over to the older wing, and up to the 7th floor. I immediately recognized the place from my prior stay, last February. It's an odd layout, the rooms extremely cramped, and the staff reflecting South Jersey's cultural schism. When I was there before, I had a paranoid roommate who was obviously neurologically impaired from years of alcohol abuse. He talked on and on about some events that took place, in St. Louis, twenty or thirty years ago. He had an altercation with the police or some other men. Two techs were sent in to calm him down. As soon as they heard him, they went on for ten minutes, talking to each other, showing more empathy than I could, for his view of the world. "Know what you mean ... can't stand that shit ... they're gonna hurt you ..." going on and specifically recounting of their own grievances against the police, their neighbors, and society in general.

I recognized one of my former nurses, whom I liked quite a lot, and Toni, the hip hopping tech, who would say whatever crossed her mind. I don't recall the specifics, but she made some highly offensive and inappropriate remarks to me the last time. This stay, she was pleasant, upbeat, and playful, but nevertheless, inappropriate. She came into the room to see Maryka sitting on the side of my bed, holding my hand. She immediately admonished her for climbing all over me, suggesting we could display more sexual self control. She had actually come to take my blood sugar. After getting an unexpectedly low reading using a finger on my left hand, she tried again, using my right hand. When this number showed a higher, more expected reading, she tried to link difference to sugar in the hand that Maryka was holding.

Once in my room, I was placed on a heart monitor, this time one that broadcast the results, without tethering me to a physical device. I was given oxygen, this time at half the volume of what I had on the ICU before. The oxygen was now my only impediment, outside my physical strength, to getting around. This led to discussions between the nurse and me regarding how I should handle my bathroom needs. She left it up to me, whether to use a bed bound option or disconnect for a brief amount of time. She suggested she might be able to get me a mobile O2 tank. She then left the room, to return shortly with more oxygen tubing. She jury rigged two pieces of tubing to create an, which reached the bathroom. It proved long enough, so when I returned, she tried to tape these two tubes together. Her efforts proved futile, as she could not get the tubes to permanently stay together. Further, there was too much loss of pressure to get me the oxygen I might truly need. The next day, this nurse led me in a walk on the floor, monitoring my oxygen level along the way. I was extremely touched by how vigilant she was.

There is a dramatic difference in the quality of hospital beds between the ICU and the my present ward. There was also a noise which continuously came from a vent in the ceiling, which was far more disturbing than a mechanical valve could have been. I did not sleep either night in that room. Still, it gave me a change to get to know my roommate.

Except for one night, I had a room entirely to myself. I was glad, since my prior experiences with hospital roommates is not very good. In February, I had two hospitalizations, one at Cooper, one at Kennedy. My roommate in Kennedy was not much better than the one at Cooper. He was an active alcoholic, not as neurologically impaired, as the Cooper chap. Whatever got him to the hospital, he was clearly itching to get himself out. I similarly disturbed roommates during my 1990 hospitalization for endocarditis.

Jack was admitted to my room shortly after I arrived. My anxieties went up from the very beginning, when he asked the nurse if he could have a drink. When his request for alcohol did not pan out, he got the tech to go downstairs, to the coffee shop, for some real (non-hospital) coffee. My initial about Jack were soon allayed when I realize that he was a friendly and jovial man.

I got to know Jack late that night, while I was wide awake, unable to sleep. I had just returned to my room after walking in the hall, when Jack also came ambling back. I did not realize he was having trouble, too. Jack and I sustained a conversation for a good half hour, until we both went back to sleep.

Jack had open heart surgery about nine years ago, at Deborah. His surgeon had completed 10,000 operations with the implication that he was the best around. Following a mental "my surgeon's better than yours," I lamely found a way to interject that Dr. Rosenbloom was recently cited in the Top Docs edition of Philadelphia Magazine. Jack did not seem impressed, and went on to tell me that he came to Cooper because he needed a pacemaker, and Cooper is closer to when he lives (with the implication he would have gone to Deborah if he needed more serious, open heart surgery). Following this brief round playground banter, we got engaged in more conversation, about ourselves, about politics and the world. Although Jack had been a blue collar worker from the boon docks of Cumberland County, I found that many of our beliefs, were truly shared.

On Saturday morning I was seen by one of the cardiology residents (or fellows, I'm not quite sure about the difference) who examined me before Dr. Ginsberg arrived. I don't recall this doctor's name, but my immediate response once he opened his mouth was to inquire, "You're from South Africa?" He held his response until completing the examination, and then told me I was right and asked how I knew. He shared that it bothers him that people often think he came from London or Australia. I told him that my grandfather was South African, and that his speech mimicked exactly sounds I heard from relatives of mine. This seem to seed a closer than doctor-patient relationship. He later asked my advice about how his mother-in-law, who is a psychoanalyst in Johannesburg, could get licensed, if she moved to New Jersey.

Jack was discharged on Saturday, so I had the room to myself that night. I still could not sleep, and got increasingly impatient to get out of there. On Saturday, I had spoken to three different doctors, Dr. South African, Dr. Ginsburg, and Dr. Bowen (Dr. Rosenbloom's associate). They all disagreed on the day of my release, respectively Saturday, Sunday, and Monday.

In the middle of that night, my nurse came into my room, to do an EKG. The technician was worried by something that appeared on her telemetry screen. The nurse tried to assure me that it was nothing to raise concern, and that the telemetry technician was just doing her job. The blip that she saw, had already been seen and ruled out as a problem by Dr. Ginsburg earlier in the day.

I've known for years that there is a blip on my EKG. It reads as if I have had a heart attack. Years ago, when I worked at South Amboy Hospital, I was given an examination and told I had such a prior attack. I went immediately to Dr. Ginsburg who repeated the test, and then assured me that this was not the case. The blip was either an idiosycratically delayed beat, or a misreading caused by my prior heart surgery. Despite my nurse's efforts to reassure me, this raised my anxieties that I would not go home.

In the middle of the night, my nurse rolls in a portable EKG machine to begin the test. Something goes wrong, and the machine spits out graphs with large black lines, causing me to wonder if I were in cardiac arrest. She told me there was something wrong with the leads (reminding of the movie, Glen Garry Glen Ross). After considerable effort on her part, she finally got a reading, which she could use. She told me that nothing had changed, and despite my worries, I felt certain I would have seen a doctor that night, if something had.

I got up in the morning, following a poor night's sleep, waiting for Dr. Ginsburg to arrive. He had told me, the day before, that he would be here at 10 am. I decided to sit in my chair and read the Sunday Times on my Kindle. At some point, Dr. South Africa came in to do an examination. He told me that it was his understanding that I would be going home today. We had a friendly and cordial chat. He left, and I picked up my Kindle, to find its screen had frozen on that page. No matter what buttons I pushed, I had no way to get it working again, leaving me feeling quite panicked that this prized possession would never work again.

The Kindle has a special place for me. I don't care for TV (with the exception of surreal court shows -- The People's Court, etc). When I was in the hospital back in February, I mentioned to Maryka that I was getting very bored with the TV on. The message appears to have gotten back to Matt, so for my birthday (which is February 18), he sent me a Kindle. I certainly did not expect such a lavish gift, and was touched by his sensitivity to my plight. It also happens to be that Matt works for Amazon, and is involved on the Kindle project. So, this adds a special connection to him associated with this gift, and considerable concerns if I were not to have it.

Before I got the Kindle, I did not actually read very much. Although many know of me as a writer, I am actually a handicapped reader with a clear learning disability. The learning disability is a consequence of my operation when I was ten years old. Before that, I was an avid reader. Many of the historical facts I know today come from children's books I read before I was ten. I mentioned before that Dr. Gross had a worldwide reputation as a pediatric heart surgeon. One reason for his success is that he was able to do surgery at a rapid clip. Without today's technology, there is significant interruption of blood flow during the operation I had. The damage that is done may depend on how long. Although my operation was successful, my loss of reading skills was dramatic.

This has actually played a very central role in my development as a clinical psychologist. I was trained in New York which was heavily influenced by the psychoanalytic approach. I assumed that there were Oedipal themes and castration anxieties, associated with the fact that I suddenly stopped reading after my operation. My mother stayed in Boston during my surgical stay, while my father had to stay home to work. Undoubtedly, I feared going blind at my father's hand for sharing this intimate time with her. This, and other misguided notions about a whole range of health and emotional reactions, have significantly altered my views on psychoanalysis, and play a major role in the psychology I currently practice.

Coming back to the Kindle, I found it not just a thoughtful gift, but a remarkable device. It's small screen combined with its options to control the size of the letters, has dramatically increased my capacity to read. Whereas for most of my adult life, I have read just one book a year, on my annual summer vacation, I've read four since February, along with my daily New York Times subscription. The loss of my Kindle would be a devastating blow.

I tried to comfort myself, knowing that it had a one year warranty, but I also thought back to that time, shortly after surgery, when I dropped my Kindle, reaching for in with my numbed right hand. Would that invalidate the warranty? I looked over my Kinder for signs of damage, and shockingly found that some were there. There was a slight separation in the integrity of the seal between the front and back covers. Undoubtedly, it had separated when it had dropped.

With some difficulty, I was able to snap the pieces back in place, still unclear about whether I would be protected. It didn't fail after the fall. But there may have been phsyical damage to kicked in later on. After continuing to push the buttons, I figured my only option was to use the power cord. I did not have it with me, and would have to wait to get home.

I put this out of my mind until Sunday evening while Maryka drove Matt to the airport. Unfortunately, I had to wait for her return, she she had been carrying the cord in her purse. I told her of my plight, and she questioned why I didn't share this with Matt, who could have taken the device back with him, if it did not work. I did not want him to feel bad, and also figured that I could settle the problem easily from home. Anyway, I plugged the Kindle in which caused the frozen screen to be immediately replaced with one that indicated, it needed to be charged. I believe the charge ran down during that day. Within a few minutes, my Kindle was working again.

It's interesting how, during a period of vulnerability, small things take on major levels of importance. Certainly, the worst that would happen is that I'd have to buy a new one. I can certainly afford a $300 item, knowing Blue Cross Blue Shield is handling my quarter million dollar operation. But this was a very special gift.

The other, unexpectedly special gift is Sir Koff-A-Lot. Before going into surgery, I was given a device called a incentive spirometer. I was instructed to use this ten times an hour, and continue to use it after I got home. This is done to prevent pneumonia, and will induce coughing if there are fluids in the lungs. Before of the cracked sternum, it is helpful to hold one's chest while coughing. Although a blanket would do, Sir Koff-A-Lot is a specially manufactured Teddy Bear, indistinguishable from his Teddy Bear cousins, except for his straighter back. This explanation is clearly described on Sir Koff-A-Lot's tags. Not quite ready to read when the bear first arrived, it nevertheless proved to be a comforting pal. I truly enjoy having Sir Koff-A-Lott around, who is currently napping in my bed. I guess surgery creates a throwback to a more primitive time, depending on others, and experiencing pride in using the potty the first time. Sir Koff-A-Lot has earned a permanent place in my heart.

Resuming the story

Up until July 8, I talked about my experiences anticipating heart surgery. The posts that followed were updates of progress but not descriptions of the experience. It is Monday morning, July 13. I was discharged yesterday and am sitting in bed, with my laptop, and ready to tell the story. I'll try to recount, as accurately as I can, what has transpired over the last few days.

I felt fairly buoyed on Tuesday, throughout the day, following our meeting with Dr. Rosenbloom. The fact that I would not get a mechanical valve, with lifelong Coumadin, and click, click, click, relieved me a great deal.

I got up on Wednesday morning, at about 4 am, after sleeping much better than I thought I would. Part of my pre-surgical prep involved a shower using a special soap on those areas where they were going to cut. Maryka, Matt and I arrived at the hospital at 5:15 am and were in the surgical section by 5:30. Things moved quite quickly from that point on. Accustomed to seeing doctors in busy waiting rooms, where not everyone knows what is going on, I was comforted by how organized they were. The nurse, who greeted me, was extremely well versed on my entire medical history. She reviewed that history, conducted a quick examination, and double-checked my preparations, and what medications I recently took. She told me to strip naked and put on hospital gown and surgical cap. Maryka, who was similarly donned with gown and hair cap, barring the requirement to be naked underneath. She followed me as I got wheeled down the hall to the surgical prep room. Adhering to a strict rule allowing just one family member to come that far, Matt stayed behind in the waiting area.

I was quickly moved to a stretcher, so that my wheelchair escort could proceed with my shave. A pleasant and comforting man, he showed no hesitation holding my genitals to the side, as he rendered, hairless, the necessary locations.

From there, my memory gets vague. I believe I had visits from Dr. Rosenbloom and the anesthesiologist. I remember seeing Maryka sitting off in the distance, wearing her unflattering hospital gear. Maryka tells me that we spoke for a moment after these preparations were done, but I don't recall that conversation at all.

I next remember lying in a room with a tube down my throat. I could see a clock, and registered that it was near the top of the hour, although I can't recall whether that was 2 or 3 pm. There was a window to the left. I was aware that there was a nurse watching me, as her position would sporadically move in and out of my view. I felt a post nasal drip and was quite concerned that the fluids would choke me as they filled up my lungs. I kept trying to cough it up, but with little success. I tried to lift my hands, to let the nurse know I was ready for her to take the tube out. It was excruciatingly difficult, trying to move my hands up. I had particular difficulty raising my right arm, which was extremely numb. Although it is getting better, the numbness in that hand continues to be a problem. I believe that my hand movements were interpreted as an effort to pull out my tube, but my true intent was to get the nurse's attention. I wanted her to know that I could breathe on my own, and more importantly, that I might die from the fluids which were entering my lungs. I believe this went on for about an hour, since it seemed the clock was again at the top of the hour, when she finally removed the tube. I recall Maryka, Matt, my mother, and Beth, Maryka's long term best friend, in the room with me.

What transpired next was totally unexpected, and would land me a spot on Comedy Central, if I could do my routine out of a post-anesthetic state. I launched into a stand-up (or I should say lie-down) routine. I recall only two of my jokes, but I was quite aware of being purposefully funny. After asking for water and being told it was too soon since my tube was just removed, I quipped, "If they took it out when they should have, I'd be drinking a damn martini by now." When someone commented about my efforts to raise my hands to pull out the tube, I told them "I was doing the Atlanta Braves tomahawk chop."

I stayed in ICU for that day and the next. Both days, I was moved to a chair. The room was quite large with a couch, one or two other chairs, a commode and medical equipment. Each day, my nurse would comb my hair. The chair they would move me to was designed to allow a number of different positions. I found it grossly uncomfortable, and would have strongly preferred to sit on the couch. I was completely unable to move without help. At one point, a medical technician came into my room. I don't recall what he did, but I asked him to place my chair in its most prone position. In the process, he separated me from my nurse's call button. I did not like this position at all, but I stayed there, helpless, until my nurse reentered the room.

On the second day, the process of removing my tubes began. Until then, I was tethered to several devices through tubes in my body. There was catheter in my penis, three wires to my heart, two tubes in my chest, and a direct line through my neck to my vena cava, allowing the administration of drugs directly into my heart. I also sported a monitor for my heart, a blood pressure cuff, and a device on my finger which measured blood oxygen level. The burden of moving with this equipment severely limited my mobility in my much weakened state.

The catheter for urine was the first to come out. I was glad to have a female nurse handle that task, and mentioned to her my belief that no man, regardless of maturity, education, and clinical experience, would fail to make a mental comparison of size while performing this task. She chuckled at my comment, understanding I was right. I asked her if it was going to hurt, and she said it would not. As much as I wanted to have all these devices removed, I was quite concerned about what pain would be involved. I remember at ten years old during my first heart operation, when they removed my chest tube, I was told it would not hurt, when in fact, it did. There was some pain as the catheter came out, although certainly nothing large enough for my to worry about. I was also struck by how painless it was all the time the catheter was in, and how freeing it felt to effortlessly pee, whenever required.

Later that day, a physician's assistant came to check my temporary pacemaker. He decided it was time to turn the device off, while leaving the leads in just case it was needed again. The PA was a jovial man, causing me to suddenly feel worried about the decision he had made. In a rare moment of challenging someone's credentials, I told him I needed a doctor, not a PA, to make that decision. He handled my request with apparent understanding. Shortly, a cardiology resident came into my room, assessed the situation, and made the same decision.

Despite my tethering to equipment, the second day brought my first attempt at a bowel movement. Although I never minded using the urinal, a bedpan exceeds what I am willing to do. So with great planning and care, my nurse disconnected some of my equipment so she could lead me to the commode, and reattach what was necessary before my bowel movement. Although it was still too early for fully solid stools, I had some success, and felt like a two year old who had just crossed a threshold in the rites of potty training.

On day two, Howard and Jane visited me. I was touched by their kindness, and it has helped me throughout to go through this together, with Howard, who had a similar operation a few weeks ago.

One point that was frequently made in my pre-surgical reading materials, was to not let myself suffer with pain. I had further read that one benefit of minimally invasive surgery, which I could not have, was that there was less pain. I was often told in the hospital not to hesitate in asking for pain medication. Yet, I experienced virtually no pain. The one exception came from the chest tubes, which would cause my left lung to hurt, each time I breathed. Although I did not consider this enough pain to require treatment, I nevertheless decided to try the pain medication. The oxycodone made me tired, and possibly a bit loopy. I recall lying in my bed with Matt and Maryka sitting on each side, holding my hands, keeping up a conversation, as I seemed to go in and out.

In the evening after the medication wore off, and Maryka and Matt had left, I felt like reading and reached with my numbed right hand to pick up my Kindle. The Kindle fell, creating instant panic that I had damaged my highly prized item, which I intended to use through the course of my recovery. I looked for my nurse call button, but could not find it. Unable to move around on my own volition, I lay there waiting for someone to come in. A technician arrived, and I asked her to pick up my Kindle from the floor. I was greatly relieved to see that it still worked.

On the third day, Saturday, the rest of my tubes were scheduled to come out, the assignment given to the PA I had rejected the day before. He was just as chipper as he had been before, and I felt confident that my challenge had not caused any offense. Again, I questioned whether there would be pain with different answers for the various attachments. The heart wires came out first, two to the atria, one to the ventricle. These came out easily without any problem. The tube to my vena cava was fairly painful, with the pain continuing for an additional few days (although never at a level where I would ask for pain medication). The tubes in my chest reminded me of how I felt at ten years of age. Although it hurt slightly, it was just for a moment.

Without this apparatus, the decision was made to move me from ICU to the cardiac ward, a much more tightly cramped room. The move was made on Friday.

I think that's a lot for my first out-of-hospital post, so I'll wait until tomorrow to pick up on my story. In fact, it is 5:00 pm and I just finished my morning post. Obviously, I am working more slowly than I normally do, but that's okay, I just had open heart surgery.

Almost went home

It's Saturday evening, and I almost thought I was going to go home A cardiology resident saw me early in the morning. His statement was highly unexpected, and turned to be untrue. Shortly, thereafter, a doctor from the surgical group saw me and suggested I might be here until Monday or Tuesday. Then, Dr. Ginzburg, my cardiologist, came by later and told me I'm going home tomorrow. There aren't many reasons for me to stay here. I feel well and can walk around. I get tired and take a nap, all things I can do at home. I've told them that I'd like to go home, but if there is a medical reason for me to stay, I will. The issue appears to be Coumadin. Even though I have a tissue valve and will not need it lifelong, I have to be on it for about two months, for my mitral valve. They put a plastic ring around the mitral valve when doing the repair. Some scar tissue is expected to develop around the ring, so they have to inhibit clotting while that happens.

Otherwise, things are going very well. My heart is pumping regularly. I've been off oxygen today. I'm certainly getting better much more quickly than I would have predicted.

Please excuse any typos in this post. I'm not quite up to proofreading what I wrote, as I usually do.

First Post After Surgery

It's the day after my surgery and I'm dictating this blog to Matt who is handling the technical aspects of my blogging for a while.

The operation went well. They replaced one valve and fixed the other. And for the first time in my life, I don't have a heart murmur. It also seems that I've got a career in stand up comedy as long as I make sure I come out on anesthesia. I've generally felt good except for some pain today. And I did just have my first solid food.

More to come when I am more active.

Wednesday Morning

It's Wednesday morning, July 8, 4 am. I just finished my shower and at-home surgical scrub in preparation for going to the hospital, to check-in, not for same day surgery, but for a major heart operation. The insurance company prefers it this way, saving the cost of one night's hospitalization. I slept well, largely because we saw Dr. Rosenbloom yesterday morning. In what seems a sudden reversal (although he suggests we might have misunderstood him before) reminiscent of John McCain's 2008 campaign strategy, Dr. Rosenbloom now suggests, seems to even favor, and suggests he would do it himself were he having heart surgery, that, in the event I need two valves, he would put a tissue value in the mitral position. Maryka and I were both shocked, yet extremely buoyed by this reversal. I think this is why I slept as well as I did, and am happily blogging at this very moment.

Last post before surgery

It's Tuesday. We saw the surgeon, and now it seems that, if I need to replace the mitral valve, I can have a bio valve, for that one as well. That's a relief. Click, click, click, click, plus Coumadin off the have-to-deal-with list.

I'm keeping this post short. Matt is in town and I'm really enjoying our time together. I'll be back on line when I get home, or maybe before, from the Cooper Hospital Internet Cafe.

You've got mail

This week, Cooper Hospital sent me an envelope with information about my coming hospital stay. In an attractively designed folder, I saw pictures of an ecstatic looking, older woman with her daughter, beaming and hugging, next to a young couple tossing their gleeful children in the air, with three pictures of hospital staff, who seemed friendly but appropriately serious. The folder provided a compilation of fundamentally unnecessary information (parking fees, visitor dining options), blank legal forms (advance directives, living will declarations), internet options, and, of course, a prepaid return envelope, asking me for $200 before I get there. The internet options and the pre-admission charge are the topics of today's post.

I had assumed that I would be out of internet contact during my stay at the hospital, but, lo and behold, Cooper provides free wi-fi service. Explaining this option, they include the Wayport Connection Guide. It has a picture of a woman, smiling, sitting in her bed, with an identification bracelet and wearing a hospital gown, with a laptop on her lap. I wonder, "Where are the tubes?" I have been picturing myself lying in bed, with a ventilator down my throat, a catheter in my penis, and an assortment of other devices inserted in every possible entry into my body. I did not realize I was going to an Internet cafe.

But the real purpose of this communication is the $200. What if don't send it in? "Mr. Goldberg, we're sorry, but we canceled your operation. Payment was not made." And $200. When I was sick in February, the bill for six days, between two hospitals, was $80,000. I am guessing that this operation is going to be in the quarter million dollar range. Shouldn't we talk about this in person? No one really discusses the charges. Just $200, and I've bought an operation.

Let's backtrack. I said $80,000, but that's not what I paid (or could have paid if I wanted). My charge is $4500, the annual out-of-pocket in my insurance contract. I've already met it, so I shouldn't really owe them $200. But the $80,000 is an illusion. They're not getting $80,000. They're not getting $40,000, or even $20,000. The total payment my insurance company made was about $12,500: $63,000 adjustment, $4500 my responsibility, $12,500 from them. Even with $200 up front, that's less than $13,000 guaranteed, most written off, some they hope to collect from me.

A couple of weeks ago, I went to Massachusetts to help Sasha buy a car. We paid $10,500 for a used Honda. We did not walk out of the showroom, not knowing what the car would cost. Yet, there is no price list for my operation. I couldn't get one if I asked, since they have to see what the insurance company, not only pays, but what they allow. Just $200, and the heart operation is mine.

I've been trying to make sense of this financing issue in the face of the larger, national health care debate. What if I were not insured? Would I be sent a bill for $80,000? How would I know that the hospital would accept $17,000 instead? We hear about people going into bankruptcy, losing their homes, because of medical debt. But are we aware that this debt comes from a bill that is nearly 5X higher than the actual cost? I'm sure there are some justifications, for this practice, based on balancing a budget and allowing for indigent care. Yet, how is this not a bait and switch scheme, in which the buyer does not know what the product really costs?

I don't hear this in the national health care debate. We talk about rising hospital costs, but we don't talk about deceptive hospital charges. We talk about medical debt, but we don't talk about truth-in-lending. I think this is one more reason for substantial health care reform.

Four days to go

It's Saturday morning. Time is running short, and so will this post. I have many things to do before the operation. Only four days to go. Yesterday, I saw my last client and started my nose gel. Today and tomorrow, I'll be writing reports. I'm hoping to get everything done before Matt comes in Monday morning. I'd like to spend the last two days, relaxing, with little to "get done."

I played tennis this morning, and felt very well, causing me to have another brief moment of doubt. I have 30 reports left to write this weekend. It's been a very busy month. Carrie and I were talking about it, and neither of us can recall a busier month in years. So, here I am, continuing to work overtime, so I can check in Wednesday morning, and have a heart operation. I don't think they'll be using my story for an episode of House.

The Countdown

We recently completed a two year electoral process leading to the historic victory of Barack Obama. Maryka and I spent hours, glued to MSNBC, hearing the same news repeated minute by minute, waiting for something to break. Yet, the only true news that really mattered came at the end, with the election results. I remember sitting with friends at church, watching the TV, waiting for the historic moment, 3 seconds after the polls closed on the West Coast, declaring Obama the victor. From one week before the election, we saw in the corner of the television screen, how many days and minutes still remained. The countdown to the end, and then it was over.

This week, I started my historic countdown to the big event. There has been a lifetime of waiting and months of anticipation. Hospitalized in February, Dr. Ginzburg later that month. Dental clearance in March. The surgeon in March, too. The transesophaghial echocardiagram, the determining test, in April. A call from the surgeon's office, asking me to set up an appointment, prior to the call from Dr. Ginzburg himself, announcing their final decision. May brought the crucial meeting with the surgeon to set the date, July 8. June 8, the earliest day I could have the needed, preparatory blood tests. These landmarks pale in comparison to what took place Wednesday this week, the historical beginning of the symbolic, but all important, countdown days. Yes, it was Wednesday, July 1, that I took that crucial step, stopping my fish oil, and the countdown began. Tomorrow, it's the antibiotic nose gel, twice a day, culminating in my last meal (well, let's not be that grim), Tuesday, July 7 (that's because I can't eat anything after midnight) and the long trip to Cooper Hospital as the show begins.

Five days and counting.

Seeing Dr. Ginzburg

I had an appointment with Dr. Ginzburg yesterday. He has been my cardiologist for the last 22 years. He is very cautious and was the last doctor on board for this operation. From a medical perspective, this was a completely unnecesasry visit, but I wanted to see him, once more, before the operation. Although I've always liked him, I felt a special humanity today. We all have habits, and I have become accustomed to Dr. Ginzburg's. He starts his office visits with a smile, a handshake, questions about how I am doing, a few light interchanges, the physical exam, feedback, and I'll see you in six months, possibly with an echocardiogram in between. We usually joke about one thing or another, and I'm out in about 40 minutes. Today, following the handshake, Dr. Ginzburg sat on a chair, crossed his legs, smiled and fielded my questions. He immediate recognized, and was sensitive to the fact that I was there for no reason other than to babble, and re-ask questions I had asked before.

Dr. Ginzburg chuckled a bit after reading Dr. Rosenbloom's (the surgeon) letter in which he mentioned that he gave me the choice of three valves. He did not expect that, and I don't think he had seen this before. Dr. Ginzburg said that they were all excellent valves, and that, in his experience, different surgeons simply get used to using one, and then keep using that valve. Who knows? I'm sure they all have well paid, manufacturer representatives who try their best to sway the surgeons in their direction. I certainly could see nothing, convincing, when I tried to review the research, to point to one or the other.

Afte I left his office, I realized that this was the first time I ever saw Dr. Ginzburg in which he did not conduct a physical examination. It was clear, he knew I was anxious and he was there, simply, to listen.

Picking a valve

When I was in the hospital in February, and there was serious consideration of doing surgery then and there, I was told that I had a choice to make. I could have a mechanical valve. I could have a tissue valve. The advantage of a mechanical valve is that it lasts forever. Its disdvantages are that I would have to be on lifelong Coumadin, an anti-coagulant, and that it makes noise. With a tissue valve, it would be silent and I would not need the anti-coagulant, although it may not hold up for the rest of my life. At 62 years of age, I am in a gray zone regarding whether I should go for the tissue valve, with its limited life expectancy, or the mechanical valve. There is one caveat, which pushes toward the tissue valve, and that is developing technology. There is a reseach project going on now, in which they are replacing heart valves through a catheter. If it is successful, and the doctors believe it will be, that technique would be available by the time I needed another operation. This would be like using a stent to treat a blockage in the coronary arteries instead of heart bypass surgery. If I had the surgery in February, my knowledge and choices would have been limited to the information I just gave.

With the operation in July, I have been given a larger number of things to think about. First, it is not completely clear that the surgeon can avoid using mechanical valves. I use the plural, valves, because he will not know whether he can fix my mitral valve until he sees it. If he can, that's one valve, the aortic, which will be replaced. He can use a tissue valve for that. If he has to replace the mitral valve, he is not willing to use a tissue valve for that (it does not last as long as an aortic tissue valve), so its a mechanical valve, with lifelong Coumadin. So as long as I'm taking the Coumadin, he would use mechanical valves for both.

My surgeon likes the St. Jude valve, a tried and true product, which has been on the market for years. There are some other valves, some he'll use, some he won't. Two valves he feels comfortable with are the On-X or ATS valve. He suggested I look them up.

For years, Maryka and I drove two cars, a Honda Accord and a Dodge Grand Caravan. The Accord, as I am sure you know, is a reliable sedan. The Grand Caravan is a family car, useful for transporting a caravan of young people, to school events, parties, and baseball games. More recently, I purchase a Hynundai Elantra, less flashy than the Honda, but clearly an econcomical, reliable car. With the children grown up, Maryka said she wanted a Mazda Miata. When she first said this, I did not exactly know what it was. But the name, Miata. Hm. Caravan? Miata? It speaks for itself. Sometimes, I drive her car, since she needs mine if she goes shopping, or has more than one passenger. Pretty neat, a 62 year old man, motoring around in a cool sports car.

So, I'm been thinking, am I going to settle for dowdy St. Jude's valve, or be hip this time: an ATS. Maybe, I should really get bold, and ask for the On-X.

My Weekly Reminder

Saturday is the day that seems to remind me I need this operation. I feel pretty good all week. I've been working overtime, getting things in order as well as making extra money anticipating lost work time. I have no sick leave, working for myself. I have the energy to do this, so it leaves me feeling doubtful, wondering why I agreed. Then, comes Saturday; tennis early in the morning, a visit to my mother for breakfast after that.

The two weeks before this one, I had to leave the tennis court early. The first week, I ran for a ball lobbed over Lee Phillips head, and was done after that. The next week, I decided to serve hard (always my best stroke), and left the game after only a half hour. This week, I decided to take it easy, and was able to play for a full two sets. Yet, running around less and easing up on my serve, I was still the most winded of anyone on the court.

Then, I went to my mother's apartment. We had breakfast. She wanted me to take her to the store, but before we left, the toilet overflowed. I shut the water off, got some cleaning supplies, and went on my hands and knees to clean up the floor. My mother kept questioning whether I was working too hard, with my heart the way it is, and I told her not to worry, it was a very small job. She's 85 years old, and I certainly did not want to leave it for her to do. It took about ten minutes. Although I didn't tell her, I was truly out of breath. Nothing serious, but certainly a reminder that I need this operation.

Small things matter

I work as a psychologist, by myself. It's just me, and Carrie, my office staff of one. I see a lot of people, for evaluations, one time only. There are some people I talk to more often, a few lawyers who send me cases, and the counselors who work at the Division of Vocational Rehabilitation (DVR). Each month, I travel once or twice to four DVR offices: Mt. Holly, Thorofare, Bridgeton and Camden. We have cordial, but somewhat formal relationships. I'm Dr. Goldberg, not Ken, to everyone there.

Last week, Carrie and I made a mistake, and I got scheduled at two of these offices, Camden and Thorofare, on the same day. I was sitting in my Haddon Heights office expecting to leave shortly for Thorofare when Liz, a Camden counselor, called to find out where I was. She had a client wanting, the first of many appointments scheduled for the day. There was no solution, and I scrambled to work things out. We called Thorofare and told them I would get there late. I rushed to Camden to see the person who was there, and a few more, until the others who were scheduled later in the day, could be called and given different dates.

It all worked out. But what surprised me was the reactions from the Camden staff when I arrived. No one expressed disappointment, only concern and relief that I was okay. They knew I was having surgery, and were extremely concerned for my health.

Today, I was back in Camden, for the last time before the operation. I felt such warmth. No hugs; the relationships are too formal. Yet, I was approached by many people, asking how I felt, wishing me good luck, shaking my hand in an extra warm way. These people are not my family, or members of my church. I don't expect that level of concern. I was truly touched.

Meeting Howard

So far, I have been focusing on things that happened in the past, carefully avoiding what I feel right now. There's a reason for that. I don't want to go. I want to hide in the bushes and make it go away. I'm actually feeling quite healthy, so I start to harbor doubts that I really need surgery. But everything is planned. My patients are aware that I'm taking this break. My referral sources have been apprised as well. Friends have offered lots of support. I feel my family's love for me. Matt is flying in. I guess there isn't any turning back now. Maybe, it'll be fun.

This reminds me of my first marriage. I knew it wouldn't work. I remember thinking, as the rabbi recited the old Hebrew text, "There's always divorce." But, it wouldn't have been cool for me to chime in, when they asked if anyone had good cause why this couple should not be wed. The caterers had been paid, and I must admit, the food was good.

I should speak up now. I have good cause for not having the operation. It's gonna hurt. They're going to break open my chest and insert a lot of tubes ... and you know where.

Anyway, let's get to the topic of today's post: Meeting Howard. A few weeks ago, I learned that Howard went to the hospital, and that he, too, had heart surgery. I kind of envied him, getting it over when things first happened. I would have preferred if they just did it then, when I was in the hospital in February. But they sent me home, knowing I'd have to come back.

Maryka and I met with Howard and Jane, last Monday. We were going to bring food to Jane's house, but she insisted on going to a restaurant instead. We met. Had a great time. Howard looked great -- upbeat, light-hearted, doing very well, and only 20 days after his heart operation. Pain, I asked him? Not really, he said. Discomfort, but not that much pain.

Thank God (or for us Secular UUs, thank whatever) for Howard. We really had fun, and I think it helped me feel a little better about what is coming up. I'm ready to go ... I think.

High Blood Pressure

I've had high blood pressure all my life. Theories of how to treat it have changed throughout. High blood pressure was one of the signs the doctors used to diagnose my first heart murmur, the coarctation of the aorta. Since the coarctation blocks blood flow at a certain place in the aorta, blood pressure is high at points north, and low at points south. Blood pressure in my right arm exceeded blood pressure in my left arm. Blood pressure in my legs was quite low. If you look closely at my right and left hands, you'll see a significant different in size, the right much larger than the left. I believe that is due to differences in blood flow during those early year. Although it can't be measured with a stethoscope and sphygmomanometer, blood pressure in my head was also very high. As a child, I had some stroke risk. As far as I know, my blood pressures leveled out after my operation.

I mentioned before that the school doctor did not pass me to play on the tennis team. The reason was that my blood pressure was high. The aortic insufficiency affects blood pressure in a different way than the coarctation. I have a high systolic, but low diastolic pressure. My heart works harder to pump out blood, raising the top number. Without a tight valve holding the blood back, pressure is low between heartbeats.

As a child, I was not on blood pressure medication. I needed blood to my feet, so I had to live with some stroke risk. At 17 years of age, when the aortic insufficiency was diagnosed, there ensued a debate among the doctors. The great Dr. Gross chose to wait and see, regarding surgery. Another prominent doctor, a cardiologist, Alexander Nadas, pressed for the operation. They gave my parents differing recommendations. When Dr. Gross, the surgeon, would not operate, Dr. Nadas decided to treat my high blood pressure. I was sent home from Boston Children's Hospital on Reserpine.

Reserpine is an awful drug. Before Thorazine, it was used for the treatment of schizophrenia. Just like it calmed down agitated folks, it sent me into a major depression. I went through the rest of my junior year of high school, in a fog. It took about three months for me to adjust to this medication. By the summer, I could function (I did manage to pass that year, but not very easily). The next year, they gave me Aldomet in place of the Reserpine, and also added a water pill. These medications continued to the end of my college years.

In 1969, I moved to New York to attend Columbia University. I decided, at 22 years of age, that it was time to leave Boston Children's Hospital and find a doctor who treated adults. Dr. Nadas gave me a recommendation, Dr. John Laragh of Columbia Presbyterian.

Dr. Laragh was a major researcher in the treatment of hypertension. He oversaw a multidisciplinary team. I called and was given an appointment with Dr. Vaughn, a member of his team, who happened to be a nephrologist, not a cardiologist. Dr. Vaughn had me take a 24 hour urine test: a 24 hour sample, followed by another 24 hour sample, four days later, after consuming no salt. Always the good patient (not the one to think of hiding in the bushes to avoid heart surgery -- although I am considering it this time around), I surprised Dr. Vaughn who, after reviewing the results, commented that I really did not consume any salt. Dr. Vaughn explained that I had no essential hypertension, the readings were entirely due to the defect, and that, because of this, I no longer needed to be on blood pressure medication. Now, mind you, I was running blood pressures which, without treatment, were hopefully at 160, and could spike to 220. Yet, the diastolic number was always low, and Dr. Vaughn insisted that I was not at risk.

With the exception of one cardiologist I saw for a couple of years, Dr. Budeau (pardon my French, but I don't recall how to spell his name), this opinion was shared. Dr. Budeau had me on a water pill. Yet, Drs. Pearlstein in Brooklyn, Williams in Indianapolis, and Ginzburg in New Jersey, all concurred that I did not need treatment for my high blood pressure.

Things changed in 1990, about ten months before I had endocarditis. I started to experience a "spider" in my right eye. Whenever I lay down, a spidery figure would cross my visual field. It seemed larger than a floater, and I had heard this can be a sign of a blood blot. I saw my optometrist who sent me quickly to an ophthalmologist, who sent me directly to a retinal specialist, with the diagnosis of a Retinal Vein Occlusion.

The occlusion is a blood clot in the vein where the retinal artery and vein are close to each other and to the optic nerve. The condition causes blindness (fortunately in just one eye). Although not in the brain, one can liken it to a stroke. Although he gave me some medications, he also told me there were no effective treatments for this condition. Dr. Brown, my retinal specialist, was the first doctor I had seen in years, who expressed concern about my untreated high blood pressure. It was his opinion that my elevated systolic pressure was not as innocuous as I was to believe. He thought I needed treatment (In later years, I began to realize that Dr. Brown's reaction may have involved a personal note. There were a few years when Dr. Brown was unavailable for unstated health reason. When he came back, he looked energetic and fit. I wished him well with his health, and gleefully patted his abdomen while proclaiming, "brand new kidney.").

I reported to Dr. Ginzburg, Dr. Brown's concerns, to which he let me know, they had just changed the theories. Whereas years of conventional wisdom said they should not treat my blood pressure, it was recently learned that systolic only blood pressure does cause harm. So now I take four different medications, with my blood pressure under control. Of course, this has still left me with over twenty years with untreated high blood pressure.

Medication

Over the years, I have been given a number of medications for preventive reasons. They fall in two categories: antibiotics and anti hypertensives. Neither actually cures anything, and neither causes me to feel any better. Of course, I can see how medication reduces blood pressure, but that's not a goal by itself. The question, rather, is how medications will keep me from getting more ill.

I have also witnessed, over these same years, major shifts in medical thinking about what should be done. This decade's conventional wisdom changes in the next. So I find myself dutifully following recommendations, to keep me well, which I are later considered to be wrong. Yet, despite the fact that the wrong thing was done, my overall health, with a few major exceptions, tends to stay stable. I don't get sick just because, for years, I did the wrong thing. This experience has impacted my perceptions of the world, my views on the medical field, and on my perspective in my field of psychology. I'll start with antibiotics.

It is generally understood that when one has a leaky heart valve, there are infective risks. It's been explained to me through a plumbing analogy. If you have new pipes, water flows freely. If you have some rust, the rust becomes a site on which things can accumulate. Similarly, a damaged valve is a site on which bacteria (or viruses, or fungi) can seed. Once settled in that site, they begin to multiply and grow. The condition is called endocarditis and it is quite dangerous. It can't be cured with simple oral antibiotics, but requires hospital treatment and weeks or more of intravenous medication. Hopefully, the organism is a bacteria, since the other possibilities are much harder to kill. Untreated, the condition can be fatal. Common illnesses do not lead to endocarditis, but blood born infections do. Consequently, it is considered important to prevent bacteria from entering the blood stream.

The American Heart Association publishes guidelines for protecting people like me, from endocarditis, with the most common concern being dental work. Evidently, we all have bacteria in our mouths. The gums give rapid access into the bloodstream. Common dental procedures, such as preventive teeth cleaning, can cause these bacteria enter. Although less likely, cuts in the gums from using dental floss, can do this, too.

Sometimes, the AHA publishes more stringent guidelines. Sometimes, they ease up. Recently, the guidelines have lessened considerably.

For me, it has been a bit surreal. When I was first diagnosed with an aortic insufficiency, they did not have these antibiotic recommendations. Dentists did not ask me if I needed prophylaxis, and I did not use it. So, I have a considerable experience of having my teeth cleaned, without this protection, without harm.

In my later 20s, I was suddenly told this was absolutely necessary. I would take medication for five days, two days before as well as two days after, when having dental work. Further, there were concerns that any infection in my mouth, even a common sore throat, could make me seriously ill. So, I had lots of antibiotics. Lots and lots of antibiotics. Every sore throat created fear, a trip to the doctor, and frequently, medication. In fact, one doctor wanted me to take an antibiotic pill, every day, for my entire life. As we now know, that practice can breed medication resistant germs. Fortunately, I never followed through on that suggestion.

In 1990, I was working at a hospital and was able to get medication from the hospital's formulary. With dental work planned, I got a supply. Something happened so that the procedure did not take place. I put the pills in my attache case, without further thought. In the fall when I did visit the dentist, I noticed I still had those pills. It did not hit me that, because I had carried them around through an entire hot summer, they were no longer potent. A few days after I saw the dentist, I developed fever. I saw my doctor. He gave me antibiotics. I felt better until I finished the prescription, and had a fever again. After repeating this routine with the same result, I had blood culture, which showed I had endocarditis.

After a three week hospital stay and four and a half weeks of IV treatment, I did get better and life went on. My new prophylaxis recommendation was IV antibiotics in preparation for dental work. For years, I had to arrange for a nurse to come hours before any dental procedure, to infuse the medication. More recently, my doctor has agreed to reduce the pre-treatment to an intramuscular injection. For this, I order the vial from my pharmacy, take it to my family doctor where the nurse gives the injection, and then mosey on over to my dentist's office. The routine is much better than the one before.

Here's the odd thing. Recently, the AHA has changed its recommendation to drastically reduce the use of pre-medication for people like me, with heart valve disease. If I were following today's recommendations in 1990, those antibiotics would not have been prescribed. Does that mean I would not have gotten sick? I didn't get sick in my 20s before they had these recommendations. Has the AHA, in an effort to not overuse antibiotics created a situation in which heart valve patients are now left unprotected? Is it still true that I, personally, need this aggressive approach to pretreatment for dental work?

I find the whole thing puzzling. These recommendations are not meant to cure an illness, but to keep some rogue bacteria from doing its dirty work. It may be like homeland security, overkilling on civil liberties, to block a terrorist cell. Anyway, I do what I'm told, and hope things works out.

Being active

In general, my heart condition did not restrict what I could do. As I mentioned before, I was not allowed to join the tennis team. Twice, as an adult, I challenged that view, by signing up for a mixed doubles tournament. Each time, I played extremely well in the first match. By the second round, I was totally shot. The doctors were right. I could not handle competitive tournament play.

As a child, I recall two restrictions. Before my family bought a one story house, we lived on the second floor in a garden apartment complex. I was not allowed to run up and down the stairs like other chidlren do. If I was playing downstairs, I had to stay there. Once I came upstairs, I could not go back.

One day, I was expecting a gift -- a portable radio. I kept coming to the door, calling upstairs, to find out if it had arrived. I was worried about what I would do when it finally came. Do I continue to play outside? Do I come upstairs to see my radio? It's odd. I have three children. I cannot imagine any of them, at four or five years of age, giving it a second thought, whether to run and gleefully see their gift. But I was worried. In the end, the radio arrived. My mother came downstairs and brought it to me.

My other childhood restriction was that I was not allowed to ride a bike. I was promised that I would get, after the operation, "the best bike in the world." My parents seemed to think that I could hurt myself braking the bike with my feet (for some reason, Goldbergs did not have bikes with hand brakes). At ten years old, I finally learned how to ride a bike.

At 12, I went with my brother on a bike ride. Suddenly, we were barreling downhill on a fairly steep grade. I was scared. I was scared of the speed, and I was more scared of pressing down on the brakes. Instead, I steered my bike into a mailbox. By the way, this was before children wore helmets when riding bikes.

My Heart Surgery

In just 18 days, early in the morning, I will be in a deep sleep, as Dr. Michael Rosenbloom begins what will be the most important operation of his career. Perhaps not to him, or to many other people, but important to me and some other people who have shared my life so far. It's not a surprise. I've waited for this day for 45 years. It almost happened in 1964 and could have taken place any time in between. But July 8, 2009, is the day, I go under the knife. Let me share my story.

I was born in 1947, at first appearing a healthy little guy. At 3 or 4 years of age, as I've been told, I stopped running around as children tend to do. My parents took me to the doctor who determined that I had a serious heart murmur. 1951 and 2009 are worlds apart. Now, the solution might be fairly simple. Then, it involved a very dangerous operation. I was diagnosed with a Coarctation of the Aorta, and the condition required a surgical response. In those days, very few doctors were having success, so my parent took me to Boston Children's Hospital (we lived in Trenton at the time), to see whom I was told was the "Best doctor in the world." As a child, I always wondered how anyone could tell. I thought there might be some other doctor, in China, on the other side of the world, who might just be a little better than he. Best? Second best? I can't say I really know, but from the reactions I get from many doctors even now, he was a giant in the pediatric heart surgery field. So, we trekked up to Boston to see, the famed heart surgeon, Dr. Robert Gross. Dr. Gross confirmed the diagnosis, but chose to wait six more years for the surgery to be done. At 10, in 1957, I underwent the operation I needed.

I was a trooper, and hung my hat on being a great patient. I went forward without a fuss, without any fear. Years later, I met a guy who had the same operation when he was a child. Getting out of the car at the hospital, he quickly ran away, and hid in the bushes. He was found, and the surgery went on. I never thought this was something that I could do. It wasn't in my character. Dr. Gross was the best doctor, and I was determined to be the best patient, in the world. The surgery was successful, and one year later, I was dismissed from the great doctor's care.

The heart problem kept me from doing the things young boys are wont to do. I loved baseball, but I simply could not play, or sustain the effort that other children did. I tried youth baseball for one year, but did not go back, it was simply too hard. A few years after I had the operation, I went with some friends to a tennis court. A less popular sport in those days, I was on equal footing with the other kids. This piqued my interest and I began to develop good tennis skills. In junior high school, I met and played with some members of the high school tennis team. They were older than me, and I was a bit behind, but nevertheless, I realized then that I had a good chance of playing on the high school tennis team.

In the fall of my freshman year, the tennis coach ran an informal tennis program. I played everyday, further supporting my belief that I could earn a spot on the team. The spring came, and I signed up for tryouts. The first step was a physical exam. I saw the school doctor, and to my surprise, he would not okay me to play school sports. It wasn't the coarctation. He found something new.

I begged to play, and pushed my mother into challenging the decision. When the doctor heard I saw the great Dr. Gross, he agreed to defer to Dr. Gross' decision. We went back to Boston but to my dismay, Dr. Gross would not let me play on the team. He had no objecction to my playing tennis, but not in a situation where I could not back out, if I did not feel well.

The next year, I did get sick, and again went to see the great Dr. Gross. This time, he was concerned. I spent a week in the hospital where I was given the diagnosis of Aortic insufficiency. There was serious talk of another heart operation, then and there. Dr. Gross, however, decided to wait a year. A year became two, and eventually 45.

That's today's post. The story will go on.