Open-heart surgery is not, if you’ll pardon the expression, for the faint of heart.
In my case, it was an intense, 6-hour operation that ended up repairing a heart that was in worse condition than my doctors and I had realized.
It was preceded by a slew of pre-surgery tests during the months before the procedure as well as the roller coaster of emotions leading up to the fateful day.
And then there are the weeks and weeks of recovery that require precise attention to a detailed plan your cardiovascular team presents to you.
However, the rewards are there at the finish line.
A new, more grateful look at life. A closer bond with family and friends. A desire to seek out goodness and beauty in the world.
Today, I consider myself a classic car with a rebuilt engine, ready to tackle my 70s.
But it was a long, difficult road to get here.
A diagnosis with no symptoms
The first sign of trouble came in the summer of 2023.
That’s when my cardiologist, Dr. Christopher Wulff, suddenly told me to be quiet while he was listening to my heart in his office in the San Francisco suburb of Walnut Creek.
I’d been going to a cardiologist every year since 1997, when a tonic-clonic seizure led to my diagnosis of a fainting disorder known as neurocardiogenic syncope. Those visits had been in addition to an annual checkup with our regular family doctor.
The syncope was, it turns out, relatively easy to manage with lifestyle changes.
The yearly visits to the cardiologist had become so routine, in fact, that I almost stopped going on an annual basis.
Good thing I didn’t. (Let this be a lesson on the importance of seeing your doctor every year.)
What Dr. Wulff heard on that day was a “clicking.” It was a sign, he said, that one of the two flaps that control blood flow into the mitral valve inside the left chamber of my heart was not closing properly.
That was causing about 50% of the blood being pumped out of my heart to flow back into the chamber, causing my heart to work harder. If left untreated, it could eventually lead to heart disease.
I was stunned. I had absolutely no symptoms. No shortness of breath. No chest pains. Nothing.
In fact, I felt great. I was exercising every day, including two-hour hikes on nearby Mount Diablo every Sunday.
Dr. Wulff ordered an echocardiogram to be done on, appropriately enough, Halloween. I got the results the next day, which happened to be my birthday. They were not encouraging.
The report stated that the left atrium in the upper chamber of my heart was “severely increased.” Dr. Wulff noted that this was probably due to the “leaky mitral valve.” The diagnosis was “non-rheumatic mitral regurgitation.”
Dr. Wulff said he wanted to monitor the situation and that “all of this is fixable when it needs to be fixed.”
Heart surgery for mitral valves is somewhat common and safe. However, my cardiologist noted that the operation is still open-heart surgery, and you don’t want to do that until it’s necessary.
The following February, Dr. Wulff conducted a transesophageal echocardiogram, and nothing unexpected was found.
Life went on until the summer of 2024. Then, things shifted into a serious mode.
Dr. Wulff detected atrial fibrillation while listening to my heart. Another echocardiogram confirmed the AFib. My cardiologist said the condition had probably developed due to the enlargement of the upper left heart chamber.
It turned out the AFib was somewhat serious. It didn’t produce any sudden rapid palpitations that a person would feel. However, the AFib was persistent. It was always there. My heart rate changed every three or four seconds. Over time, that puts quite a strain on the heart.
I was referred to Dr. Ramesh Veeragandham, one of the best cardiac surgeons around.
After some preliminary examinations, he and Dr. Wulff agreed I needed to have open-heart surgery. The kind where they slice into your chest, crack open your ribcage, stop your heart while a machine circulates blood around your body, then restart your heart, and finally stitch your chest back up.
Dr. Veeragandham would use tiny synthetic fibers to repair the mitral valve flap. He would then use what’s known as a maze procedure to create scar tissue inside my heart to get rid of the AFib.
The surgery was scheduled for Nov. 15, two weeks after my 70th birthday.
Preparing for open-heart surgery
Before I could go under the knife, I had to undergo a series of pre-surgery exams, from an ultrasound to a CT scan to blood work to an intensive catheter procedure into the heart.
I even had to have a tooth pulled because there was an infection. You can’t have any infections anywhere for this surgery.
I was also put on the blood thinner Eliquis. There is always a danger of blood clots and stroke when you have AFib.
To say all this was daunting would be an understatement. If I had symptoms, it would have been easier to wrap my head around. But to need this lifesaving operation when I felt great? It was a lot to process.
I tried not to think about exactly what the surgeons would be doing inside my chest. I had to trust the fact that they do this all the time.
Still, I rode the traditional roller coaster of pre-surgery jitters. Some days, I was fine with it. On other days, my anxiety floated up to my throat. There were quick bursts of frustration and short bouts of apprehension, but keeping busy and taking some matters into my own hands helped.
I gave up alcohol on Oct. 1. I adopted a healthier diet. I also increased my daily exercise. I knew that a fitness program before surgery could help make your recovery a little easier.
During my two-month routine, I strengthened my core and lost 10 pounds, bringing my weight to its lowest level in nearly 20 years.
On the Tuesday before the surgery, my wife, Mary, and I met with the surgical team.
The session started with a hospital volunteer named Alan, who had undergone bypass surgery in 2006. He told me what to expect in the hospital and when I went home. His words were invaluable.
There was also blood work, a COVID-19 test, and a chest X-ray.
Then, a cardiac navigator named Jodie gave me homework to do over the next few days. This included strengthening my lungs with a plastic breathing cylinder, applying a topical ointment in my nose to kill any potential bacteria, following special shower instructions for Thursday night, and drinking a nutritional powder on the morning of the surgery.
She informed me the surgery would be 4 to 6 hours. The incision in my chest would be 10 inches long. I’d be on a ventilator during the operation to help my lungs breathe.
She also precisely detailed how the 4 to 6-week recovery would play out: a slow, progressive exercise buildup with daily home checks on weight, temperature, and blood pressure.
The scenario was a bit overwhelming, but information is power. Plus, at this point, I just wanted to get the surgery over with. The operation had been dominating my thoughts for two months.
So, I told myself that on Friday, I was going to be part of an amazing adventure that not many people experience.
During the next few days, I prepared for this long rehabilitation by finishing chores I wouldn’t be able to do for the next four weeks. They included retrieving the holiday decorations from the attic and digging up the summer garden.
When I could feel anxiety rising, I would tell myself: “The surgery is not today. You don’t have to worry about it right now.”
For inspiration, I recalled Mary’s courage and resiliency during her one year of breast cancer treatment in 2018, which included chemotherapy, mastectomy surgery, and radiation. My ordeal was nothing compared to what she went through.
I also tried to be grateful that there was a one-time surgery that could fix my problem. There aren’t any such procedures for Alzheimer’s, amyotrophic lateral sclerosis (ALS), or a host of other deadly diseases.
Surgery day
On surgery day, Mary and I arrived at 5:30 a.m. at the John Muir Concord Medical Center. I was relatively and strangely calm in the morning darkness.
We went to the cardiovascular care wing. After the usual check-in and pre-op set-up, I was rolled into the operating room shortly before 7:30 a.m.
When the anesthesiologist put the mask over my mouth, I was relieved.
The next thing I remember was slowly becoming conscious in a room in the cardiac intensive care unit. I was drifting in and out of some heavy slumber. It felt like I was fighting against ocean waves.
Two nurses, Lindsey and Sophia, were at the foot of the bed, yelling encouragement. “David, David! Stay awake! Deep breaths!” Thanks to their loud pleadings, I regained consciousness.
I would learn over the next 36 hours that the nurses in the cardiac ICU are the absolute cream of the crop. It’s obvious the medical center selects the best of the best to work in this all-important unit.
Once I was settled, I learned that Dr. Veeragandham had indeed repaired the mitral valve flap and had successfully built that maze wall to block the AFib.
However, when he was in there, Dr. Veeragandham also saw that a flap in the tricuspid valve was also broken, which he repaired. In addition, he noticed a tiny hole between two chambers in my heart. (Probably a birth defect.) He fixed that while he was there.
In the words of another surgeon at the medical center, the surgery had been “extensive.”
The long road to recovery
In the cardiac ICU, the recovery program began. The nurses keep an eye on everything from glucose levels to potassium to water weight to blood pressure to temperature to urine output.
Opioids were used to dull the pain from the incision on my chest, my broken sternum, and the drainage tubes in the middle of my abdomen.
I was also hooked up to so many machines that doing anything, in particular going to the bathroom, was a slow, painful chore.
Sleep did not come easy, either. Hospital beds are small and hard. It’s also difficult to get comfortable when you are told not to shift too much. When you nod off, you are summarily awakened while a nurse checks one thing or another.
On the day after the surgery, I was able to walk to the end of the hall and back. The following day, I completed a loop around the cardiac care units.
With that, I was able to “graduate” to the progressive care unit next door.
When I landed there, I told the nurses I wanted to get off the hard-core opioids. I was concerned about the side effects, in particular, the horror stories I had heard about constipation caused by the strong pain medications.
I was put on a rotating schedule of Tylenol and a less harsh synthetic opioid. I was given one or the other every 3 hours. The plan seemed to work.
My walking increased. I was doing the cardiac unit loop three times a day. I looked forward to every one of these walks. I even cruised through the route without the assistance of a walker.
Mary came every day, and I received visits from my two daughters, both sons-in-law and two grandchildren.
Still, sleep deprivation made the days long and the nights longer, as did boredom. I could only read so much and do so many crossword puzzles. Mary and I started to watch old sitcoms such as “Seinfeld” and “The Office” on Comedy Central. That killed time, and it was so good to laugh.
A new lease on life
Dr. Veeragandham informed me that the top half of my heart and the bottom half of my heart were both beating just fine. However, they could not synchronize properly. I wouldn’t be able to leave the hospital until they did.
The solution was a pacemaker.
Dr. Anurag Gupta was called in. He’s considered the best around in this type of surgery.
The implantation of a pacemaker was scheduled for 2:30 p.m. that Thursday. The final piece of the puzzle.
Everything seemed to be in place. The finish line seemed near.
However, sleep deprivation and the series of disappointing reports I had received since the summer of 2023 took over.
Thoughts percolated in my mind as only they can when you are lying in a hospital bed at 4 a.m., exhausted with nothing else to think about.
What if the pacemaker didn’t work? What if it couldn’t get the two halves of my heart to synch? Would I be staying at the hospital indefinitely?
The doctors and nurses all assured me it would be fine. The pacemaker would work, they told me. It always does.
Thursday afternoon finally arrived, and I was wheeled into the operating room for the second time in six days.
The casual manner of the dedicated surgical team made me feel better. This isn’t that big of a deal, I thought as the anesthesia took effect.
When I awoke, I was being transported to a recovery area next to the vast nurses’ station in the surgery center.
No one needed to confirm the surgery’s success for me. I glanced up at the monitors and saw the two halves of my heart beating in a beautiful synchronized rhythm: beep-beep, beep-beep, beep-beep.
The team parked me in the recovery sector and went about their business. Dr. Gupta stopped by to tell me everything went well.
As I lay there, I realized what this meant. I could go home tomorrow. I could begin a 4-week recovery process in which I would get healthier and stronger every day.
A fitness routine that increased every week. A low sodium diet. A parade of pills to keep everything in check. Actual sleep in a big, soft bed. Visits from a home healthcare nurse and a physical therapist.
No driving for another three weeks. In fact, I needed to sit in the back seat of a car when I was being transported, mainly because the doctors didn’t want an airbag hitting my chest. (Yeah, me neither.)
Mary told me she learned from her cancer treatment that you come out the other side with a different view of life. I could already see the visual outlook changing.
It’ll be interesting to see how all this manifests in the weeks and months ahead.
Mary and I have a new lease on life together. She, the cancer survivor, and me, the heart surgery survivor.
All that, however, was ahead of me as I lay in that recovery area, just staring at the monitors. Beep, beep. Beep, beep. Beep, beep. Perfect harmony.
As I watched, tears began to leak from my eyes. I kept wiping them away. They wouldn’t stop coming.
I mentioned the wave of emotion to one of the nurses as he began to unhook me from the various machines.
“No shame in crying in this room,” he said.
He was right. Tears of joy were absolutely appropriate right now.
