Reprieve

We've gone through a week of hell, a slight cough precipitating an X-Ray which revealed, as I had expected, an old pleurisy scar from my college days.  But that is just the beginning.

Ah, those college days when we thought time was a personal continuum, guaranteed to last forever, and so we did whatever we liked, reckless things at times.  I was studying for finals in my Sophomore year and the dormitory was ablaze with late night studying, frequently with the help of NoDoze, strong coffee (or caffeinated tea in my case) and a cigarette burning from my lips or ashtray.  We were on a caffeine induced self-perpetuating high -- a contest of how long we could stay up, and memorize for those tests, walking around like zombies and proud of it.

After finals I collapsed and developed pleurisy -- in fact a very serious case -- and I was brought over to the Brooklyn Hospital, put in a ward with some twenty other patients, and had a female pulmonologist assigned to me (unusual in those days).  I never forgot her name as I found it almost comical: Dr. LafLoofy.  She tested me for, among other things, Tuberculosis, and suspected I had some form of it, but never confirmed though.  But the pleurisy was her main concern as I could hardly breathe and the pain was almost intolerable.  I was given dosages of antibiotics or penicillin, vintage 1960's, and they were even considering drilling a hole in my back to extract fluid, but it never came to that.  The worst pain came from coughing or laughing.  Visitors were told not to make me laugh and all would arrive with such somber faces that I would immediately burst out laughing, then howl with pain, as they quickly but still somberly retreated.  No more visitors for me.

So I spent two weeks in the ward, while the medications did their job.  My companion most of the time was Theodore Dreiser's "Cooperwood Trilogy."  It seemed like such a perfect piece of literary work to consume during my infirmary.

When I finally emerged from the hospital, I swore off all-nighters, took a little better care of myself, but I was right back smoking, and continued to smoke a pack to a pack and a half for the next 13 years.  I had smoked three years before, so that's 16 years of smoking plus both my parents smoked and our house and car were always a blue haze of smoke.  Those were simply the days when everyone smoked.

Fast forward to this past week.  So, when my slight cough could not be explained, my Internist took an X-Ray which to no one's surprise revealed that old pleurisy scar from a half century before.  That being explained, he put me on an antibiotic, but the following morning he called me to say that he decided to compare my current X-ray to one taken two years ago as a precaution. He thought he saw a change in that scar and thus a CAT Scan was ordered.  He called the next day with scary results; I had an 18x18x23mm mass in the upper left lobe, partially calcified.  This was completely unrelated to my pleurisy scar, so it was considered an "incidental finding."  I was referred to one of the top thoracic surgeons in the area.  We were stunned.

The anxiety level for me and my wife started to go off the scale.  I probably spent most of that day on the Web reviewing the sad, gory details about lung cancer, something with which I was already familiar as one of my best friends, Howard, died of the disease at only 62 and I know what he went through.  It has to be one of the worst cancer deaths, surgery, radiation, and chemo, mostly ending in limited life spans.  What's the point I thought?

The first appointment I could get with the surgeon was not until the following Tuesday, a wait of four nerve wracking days.  Before all this began, Ann had already left to attend a Jane Austen Society of North America convention in Minneapolis, where I insisted she stay, so I was alone for those four days to do more research which only resulted in more anxiety and the need for accepting whatever fate was about to throw at me. 

It occurred to me that as I handle all investments and bill paying, running the house, my poor wife could be left with a quagmire so I spent a good part of this time, piecing things together, trying to put together a coherent document for her.  In effect, I was doing that hackneyed phrase of "getting my affairs in order."  I was preparing for the worst, hoping for the best, but getting done now what I might not be able to once operations and/or treatments began.  I even reviewed our Trust documents, found questions regarding that, and made a list to discuss with the firm that would become the trustee.  Luckily, friends were around to have dinner with, so there was some diversionary activity, but when I returned to the quiet house at night, dark thoughts interceded.

Finally, Ann returned home last Monday night and so, together, began a week of Doctors' visits, testing, and anxiety.  The surgeon reviewed the Cat Scan with us and was brutally frank in his assessment: it most definitely appears to be cancerous and because of its location and my prior thoracic battle with open heartsurgery, made it unlikely that I would survive the "gold standard" surgical operation of removing the mass.  His recommendation was the "Cyberknife" alternative, a remarkably non-invasive method of "cutting" out the tumor with high dosages of radiation that are aimed directly at the tumor from multiple angles. 

I wondered why everyone would not opt for that treatment, but I suppose the gold standard of surgical removal is "gold" for a good reason.  He explained that when a needle biopsy is done through my back and into the lung, the radiologist would leave a fiducal marker which would be used as a target for the radiation treatment.  As anyone can imagine, we left his office reeling with fear and dread.

First, though, he ordered a PET Scan which I had to prepare for, hoping that it would not reveal any other cancers in my body.  Preparation included not eating any foods with carbs or sugars the day before and then fasting the day of the procedure. The afternoon of the PET Scan I was injected with radioactive isotopes (with their caution that I can't be near children or small pets for six hours afterwards because I would be emitting radiation).  After injection, I had to go into a dark "quiet room" so the radioisotopes could be fully absorbed by my body.  Nearly an hour later, I was led into a room with a long, narrow tube where a full body PET scan and CT was  performed, and had to lie perfectly still in this confined space for a half an hour.  Given what I was likely to go through afterwards during the next several weeks, I thought this a piece of cake.

The following morning, we had to pick up the PET Scan (all images on a disk of course) as well as a radiologist's written report to give to my surgeon with whom we had an appointment only 20 minutes later.  Naturally, we opened the report in the car beforehand, looking for any sign of malignancies elsewhere in my body.  Hooray, there appeared to be none, but reference of course was made to the tumor in my upper left lobe.

So, we arrived at the surgeon's with a list of questions regarding the biopsy, the need for a marker (collapsed lung is frequently the consequence of fiducial markers), the timing of all of this (Ann had a trip to Africa planned which she was planning to cancel that very day), when treatments would begin, the required follow-ups, and of course the prognosis.

When the surgeon and his nurse entered the room, I told him we had peeked at the report, was thrilled there was nothing else, and then started to ask him about the biopsy.  He said, what biopsy, the tumor is benign, that the Pet Scan clearly showed that.  We were stunned.  What?  Huh?  No, he said, the scan showed there were no active cancers.  We had won the lottery he was glad to report (no apologies about his prior certainty that it was cancerous).  Unfortunately, we did not recognize the "doctor speak" when reading the PET Scan report. Phrases referring to the mass --- such as "this is grossly stable; no abnormal uptake is identified" were key, identifying no active cancer, no need for a biopsy at this stage, and only a CAT Scan follow up in 6 months. The tumor might be an old TB granuloma (my speculation), and if so the likelihood that it will become active after all these years is slim to none.

We left his office both stunned and elated, hugging and dancing in the parking lot of the medical office, shocked at this totally unexpected piece of good news.  But the whole experience left me with renewed appreciation of the struggles of any cancer patient and I remember friends such as Peter, Lindy, and Howard, all of whom died of the disease, and of course my own father who had perhaps the worst, pancreatic cancer.  My friend Jeremy (one of Peter's sons) had pancreatic cancer but it was the type that could be addressed by the radical Whipple surgery.  He went through hell, and as a relatively young man, but survived.  It was the same kind of pancreatic cancer Steve Jobs had but who, instead, chose a naturopathic route.

Luckily, we hadn't told the world about the "fact" that I had lung cancer.  We wanted more details from the biopsy first. Nevertheless there were a handful of friends, and of course our sons, who knew what we were going through.  Support is such an essential element in facing this dreaded disease so we thought we would bring a few into our beginning nightmare.  To those we involved in this tale early on, thank you for your emotional support, and we're sorry you, too, were taken on such a distressing emotional ride.

I had but a brief glimpse into the emotional path cancer patients have to walk -- into a void of fear and unknowns that the medical community might be inured to, but not the patients and their loved ones.  I was certain I had read something very profound on that very topic and discovered that a few years ago I had already quoted it in my blog, but it bears repeating here.  It was written by John Updike in his Widows of Eastwick, towards the end of his own life and only one who has walked the walk could have written this (in the novel, Jim has cancer): Jim's illness drove her [Alexandra] and Jim down from safe, arty Taos into the wider society, the valleys of the ailing, a vast herd moving like stampeded bison toward the killing cliff. The socialization forced upon her -- interviews with doctors, most of them unsettlingly young; encounters with nurses, demanded merciful attentions the hospitalized patient was too manly and depressed to ask for himself; commiseration with others in her condition, soon-to-be widows and widowers she would have shunned on the street but now, in these antiseptic hallways, embraced with shared tears -- prepared her for travel in the company of strangers

Briefly I had thought that was to be my own fate, and, just as worse, Ann's, but thankfully not yet.

Anniversary, Time and Again

I started to write this entry, one which was to mark the second anniversary of my open heart surgery. It was to be an upbeat commentary, following upon a wonderful week we had just spent with our very good friends Beny and Maria visiting us from Palermo. But when I sat down to write a draft, heartbreak intruded, perversely imitating the ethos of Exit the King which we saw only a few days earlier.

Last Monday morning we received a call from Suzanne, the daughter of Ann's cousins, Sherman and Mimi, who had suddenly arrived in Florida where her parents now live. We immediately thought of her father, Ann's first cousin, Sherman, who had just been released from a prolonged hospital stay and ninety days of rehab, who can no longer walk without assistance, and has advanced dementia.  His wife of 56 years, Mimi, had been by his side every day and was now caring for him at home with the help of round-the-clock nursing aids.

But exactly on the second anniversary of my being put into a four day induced coma after open heart surgery, Ann and I rushed to the ER of a Broward hospital that Monday night, as it was not Sherman, but his caregiver, his wife Mimi, who had collapsed and was in a coma. Mimi had been like a big sister to Ann, particularly during Ann's first years in New York City when she arrived as an eighteen year old, fresh from high school graduation in her hometown, Atlanta.

They became close companions in spite of the 11 year age difference and loved living in the Big City which was Mimi's adopted town as well. They biked down to hootenannies in Washington Square park in the early 1960s, went to jazz concerts and Operas in the Village, dancing at the Latin Quarter and Roseland, enjoyed folk singing concerts, Shakespearean plays in Central Park, and took trips to Philadelphia and The Cape and Newport, RI together.  Mimi was her mentor to NY life and they became best friends.

Fast forward, closer to the present. Mimi and Sherman had moved to FL part time when Sherman retired from his long tenure (1960 - 1992) as a Physics professor at FDU.  They were happy in the community they chose in Coconut Creek, but rather recently, Sherman was diagnosed with Alzheimer's.  Rather than commit him to a home, Mimi was determined to stay in their complex, selling their upstairs apartment and buying one on the ground floor for easy egress, and hiring competent home healthcare aids for her husband.  In spite of their age (83 and 85 respectively), she was determined to shelter her husband in familiar surroundings rather than consigning themselves to an independent / assisted living facility.  

Mimi was like a force of nature, self actualizing and one always thought indestructible until we got that call last Monday from her daughter, recounting the sketchy facts as she knew them at that point:  her mother had had a very severe headache, and soon thereafter passed out.  It was a severe brain hemorrhage and she was rushed to ER and when we saw her, unconscious, on a ventilator and life support systems, those memories of my own medically induced comma came flooding back.  But this was very different.

We returned to see her on Wednesday. and Friday and during that time, testing for brain activity was negative.  She was moved to ICU and she lay there looking peaceful, even healthy except for the tubing and the wiring that was basically breathing for her and keeping her hydrated.  Their son, Michael and his wife Miriam, had arrived as well and the decision was finally made to transfer Mimi to the Hospice unit of the same hospital and to disconnect her from life support.  Friday was a day of misery for all.  Suzanne and Michael, of course, carrying the brunt of the grief, we and others there trying to support them. but being deeply distraught as well.

Mimi was a special person.  Her home was open to all.  If a foreign exchange student needed room and board for a school semester or even a school year, Mimi would provide it. If there was a foster child that needed looking after, she stepped up.  She sat with friends who needed care, wrote long letters to each and every one of the hundreds of friends she made along the way, her giving knew no bounds; she was larger than life, the last person one would imagine dying so suddenly.  But she lived life with zest and a song, particularly folksongs and Broadway melodies.  Her children set up a CD player at her bedside and we listened to all her favorites while waiting, waiting, for any sign of life.  When I first entered the room, I heard "Don't Fence Me In" being sung.  When she was taken off of life support she died with the refrains of a Pete Seeger folksong in her ear.

Our hearts go out to Suzanne and Michael, such difficult decisions, but the right ones.  We all recognize that Mimi really died the moment of the massive brain hemorrhage and she only medically survived as the 911 EMT was so swift and efficient.

My own memories of Mimi go back now about 44 years, one of my favorite was a vacation the four of us took up to Lake George, enjoying Oktoberfest at a resort and even managing to get them both out on the Lake itself for a boat ride.  And how do we count all the many family gatherings as well, Mimi and Sherman and Suzanne and Michael were always there, at our home in Weston, CT or we at theirs in New City, NY. So many years, so many wonderful memories. 

As King Berenger says in Exit the King, "Why was I born if it was not forever?" Thanks to that play, I've become pretty hung up over how I "spend" my time.  (what an expression -- time as some sort of a currency, only one that you can't make any more of.  We're all born with a certain quantity in the bank, unequal ones thanks to genetics, environment, accidents, and the twists and turns of life, and choices we make.  I guess we "buy time" with medical advances -- I certainly have.)

I suppose that is one of the main reasons I write this blog.It is not only a record of where my time goes, but it also forces me to think about it.  I could more easily just go see a play or read a book, but I would surely forget about much of it and perhaps understand less of it without delving into the details with an essay.  It is of course merely my take on those matters and, to a degree, I probably remember the past here as I want to and record the present as I would like to remember it in the future. It matters little to the world, but as I've said frequently, I write this mostly for myself. 

Others live those moments on line differently.  I don't Twitter, those ephemeral little birds of thought that go out there and then get lost (or is there a database of Tweets?).  Then there is the ubiquitous Facebook which could be easily renamed "Hey, look at me!"  I guess we're all trying to be the stars of our own reality shows.  One could accuse my blog as being just one big self indulgent look-at-me exercise, but I would like to think that the differences (between this, Twitter, and Facebook) are obvious. This endeavor really does involve a lot of thought, albeit perhaps time not wisely spent, so I return basically to the beginning of this entry, anniversaries.

Given my medical history, every day since my heart surgery and comma of four days has been a "bonus" day.  Even before Mimi's ordeal, I was fully aware of the approach of this anniversary during the last few weeks. It hit home as our friends, Maria and Beny arrived for a brief stay with us from Sicily. Only two months after my operation two years ago I had flown to Sicily (where Ann already was visiting her best friend, Maria), to join everyone in the celebration of Maria's son's wedding to Mariana, and meeting Mariana's parents who were so thrilled to have their daughter marry David.  It was undeniable that the two sets of parents had become best friends and loved being together. The year following their wedding was hell as within months, Mariana's mother was diagnosed with cancer and sadly she is also now gone, a relatively young and vibrant woman just turning 60.  All of that just during the last 24 months.  

With Maria and Beny here, we were able to "spend" some quality time with them, including a day on our new boat, the 'Reprise'. Coincidentally, we planned a small trip up the Intracoastal to  Guanabanas Restaurant in Jupiter, one that we had last been to by boat with our friends Cathy and John only a week before I entered the hospital for that surgery which turned out to be much more serious than anyone could have imagined.  (In fact, as we gaily ate lunch with Cathy and John, my "widow maker" artery was already 99% blocked, of course unknown to me, and I was a candidate for a massive heart attack as I munched on my grouper.)

Arriving at Guanabanas with Maria and Beny I could not help think of the irony of being there again, precisely two years later.  How strange it all seemed, but our visit with them was wonderful, the weather finally cooperating for boating, the clear blue water near the Jupiter Lighthouse reminding us of the waters of the Bahamas.

Meanwhile, I conclude this sad anniversary entry with other photographs of Mimi and Sherman, and Ann and I, taken during that Lake George vacation more than thirty years ago.  Although scanned from faded black and white prints (I used to do my own developing in those days), they capture the essence of her personality (she's in the foreground on the right in each).  This is the way I would like to remember her.

 

April Fool Anniversary

It is a one year anniversary of sorts for me today. Ironic it should be on April Fool's day, as it was no laughing matter. Some of the details of what I write about below were also covered by the entry I wrote not long after that day but I purposely did not revisit it before writing what follows, not wanting to be influenced and knowing that I would repeat some of what I wrote. But I recall not revealing some of the details and my feelings when I wrote that entry. I was too close to the event.

I had entered the hospital in late March for what I thought would be, yet, another stent, perhaps butting a stent inside one that had collapsed. A tricky operation, yes, but more routine than the dreaded alternative, bypass surgery. In spite of being in good shape all my life, eating healthily (well, at least relatively speaking), exercising, and, even having low cholesterol, my parents both had heart disease and I've resigned myself to being the victim of bad genes. Of course I'm not unique in this regard and I do the best I can.

But surgery did not go well, my returning to consciousness soon after I went under. The nurse in recovery looked somber, saying the surgeon would be in to explain. I knew what was coming. The interventionist cardiologist said he was referring me to a thoracic surgeon, the best in the area, as he could no longer address the widow's maker blockage with stents. Back in my hospital room I met Dr. Katz who was to operate on me.

He said I needed a dual bypass and he intended to do this surgery off the heart lung machine. In other words, on the beating heart. Open heart surgery. Images sprung to mind of his having to work quickly between heart beats, conjuring up a scene from a Woody Allen movie.

"Don't worry," he said, "I've done this before, in fact many times before. But here's the problem, we have to wean you from Plavix before the surgery because of the risk of excessive bleeding. It'll take days to work it out of your system but we can't discharge you as we wait because your artery is so blocked that you could have a heart attack anytime and you should be here. In a sense, we have to balance the risk of early surgery against the one of you having a significant heart event."

Nice euphemism, "significant heart event," not the words one wants to hear. So the wait began. Tests were taken at regular intervals which revealed I had acute sensitivity to the blood thinner so it would take days, how many they didn't know. Finally, on March 31 they said, surgery tomorrow, they couldn't wait and they were hoping the Plavix factor had diminished.

Happy April Fool's day I thought as I was being wheeled into the cardiac surgery theater. All I can remember is the cold, the high tech monitors, and a team of medical personnel ready for a full court press, March madness still being in the air. The thought went through my head that I might not survive this surgery and these might be my last conscious moments of my life, with strangers, in this sterile room. But the human psyche is innately optimistic and I looked at my surgeon and saw how confidently he was orchestrating his team, and I went under.

I woke up four days later.

My previous entry recounts much of those details, but essentially, excessive bleeding and traumatic intubation mandated not only opening me up a second time, it also required that long period of controlled unconsciousness. Ann says at times I wildly gestured to her when she visited, none of which I can remember. Mittens restrained my hands so I could not pull out myriad tubes entering my body, but, in particular, the Tracheal intubation tube down my throat. I was not a pretty sight, as the gruesome photograph clearly depicts. (I'll not post it again, but a link is here).

Did I see my life flashing before me, lights at the end of a tunnel? I don't remember anything of those four unconscious days.

But when I did awaken, I was in cardiac intensive care. Jon and Ann were there. The surgeon visited and recounted the details. My body felt bludgeoned. I was given a "cough bear" -- a little teddy bear to hold to my chest in case I had to cough up anything, something to press on the wires holding my sternum together, more of a reminder not to expand my chest for any reason. I was told that I would be in intensive care for at least two days before I could go to the cardiac wing and as I was in a coma induced sleep for four days, to expect not to be able to sleep during that entire time.

After my family left for the evening, there I was, alone, clutching my bear. I didn't have the strength or the inclination to read. Just trying to get comfortable and minimize the pain was enough of an effort. So I was left with either my thoughts or the TV to pass away the agonizing long hours of the nights. I found my thoughts somewhat depressing. Will I recover and be able to resume my life as if this never happened (it didn't seem possible at the time)? Why me? (I've asked that question many times regarding my heart issues, and blockages and high blood pressure are not the only ones, as I also have a pacemaker; my body's electrical system was shot by the time I reached my mid 50's.)

So, I turned to the TV. Do you have any idea of what is on basic cable channels during the wee hours of the night and early mornings? I had to suppress a laugh watching the numerous ads for mattresses, sleep aids, etc. Those lucky people in the real world who can't sleep only because of insomnia. I'd trade places with them in a heartbeat (no pun intended).

While the TV was on low to keep me company, I closed my eyes most of the time just to pretend a sense of normalcy.

Night "life" in a cardiac intensive recovery wing consists of hearing other patients sometimes moan in pain. I don't think I did that, although the sense of discomfort on the one to ten scale was eleven most of the time. Worse, I heard a doctor and a nurse nearby saying the patient in the next room had just died and to contact his family. Right next to me. It could have been me, I thought.

Then, there was the night nurse from hell. I suppose nurses fall into the bell shape curve like any other group of human beings, there being a few exceptional ones, most merely competent or average, and a few very unexceptional ones. In my case, I would draw the curve with many more on the exceptional end, especially the cardiac nursing staff.

But first, nurse from hell. I don't know her name (AKA Nurse Ratched, "NR"), but she was on duty my first two sleepless nights, the ones when I was in the most pain, and, frankly, most fearful of the outcome of all of this.

NR obviously took enjoyment from her position of power over her patients. I don't want to cast aspersions at the airport TSA personnel, but, face it, some enjoy the same relationship with the travelers they control.

This woman had an acerbic flair for mockery as well. That first night of interminable consciousness, after my wife finally went home exhausted, NR had obviously overheard Ann referring to me as "Bobby," a moniker I don't particularly like, but Ann (I call her Annie though) uses it and therefore some of my closest friends who have been around us a long time, call me that as well.

NR obviously took a jealous aversion to my wife and in the middle of the night I could hear her at the nurses' station (they don't realize that their chatter at night drifts down the hallways a long distance, sort of like being downwind of an anchored boat in the middle of a calm night), mocking "I wonder how 'Bobby's bear' is doing" (meaning the bear I was hugging to keep my chest together). She noted my wife's jewelry (some pieces jangling when she walks, Ann arriving like a brass band) to her co-workers, something that I guess incensed NR.

Then, one of the few times I buzzed the nurses' station in the middle of the night because of the extreme discomfort I was in (or pain, I hardly could tell the difference), and needed someone just to move me slightly to one side or the other (I was incapable of moving myself with all the tubes coming out me, the catheter, etc.), she reluctantly assisted me, but menacingly whispered in my ear, "you ought to back off that buzzer, we have other patients here."

So besides the insufferable but benign TV, I had this real life John Claggart from Melville's Billy Budd to deal with. I really saw her in those terms, not that I was the embodiment of innocence, but I was at my most vulnerable. These thoughts raced through my mind: If I ring for help, might she take vengeance for bothering her? If I report her or tell my wife to report her, what would those consequences be? I was determined to make it out of intensive care alive, and then deal with it. I asked Ann to "dress down," cryptically saying "I'll explain later."

In retrospect, I should have said something then and there, but when you are that vulnerable, your mind works differently, and believe me, in the middle of two sleepless nights, you are really ALONE.

So I clutched my bear and bore it, the sleeplessness and the terror of Nurse Ratched (although the one in the film based on the Ken Kasey novel was a lot more attractive but equally evil). But she was not the only nurse on duty, thankfully; all the others were wonderful.

For instance, on the opposite end of the spectrum was a day nurse who was the model of efficiency and good humor. Why? Because her first comments to me was that she was somewhat dyslexic (just my luck I thought) but, as a consequence, everything she needs to do for each patient is on a checklist (she showed me her personal clipboard). Sure enough, she methodically went through her list each time she saw me and didn't miss a thing, and she had me laughing to the extent that I could.

When I finally graduated to the regular cardiac care unit (and to my first night of sleep), I was greeted by the nurses who I already knew as I was in the cardiac rehab program before my surgery because of my prior stents. It felt like going back to family, all wonderful nurses who are in the unique position of following their patients from the nadir of their hospital stay, to their eventual discharge, to their offsite rehab. I still go to the rehab gym to this day, one year later, to get on the treadmills and the exercise machines, back to form before all these cardiac problems enveloped me. I can't say enough about the help and encouragement of that nursing staff, the higher end of the bell curve I described earlier.

Once out of intensive care, I took my first steps with the help of these nurses, very tentatively, my legs feeling like rubber bands, with their arms around me. They said, "don't worry, every outing will get easier and longer." And they were right.

So here I am exactly one year from the day I went into a four day coma, and a brush with death. To say I am grateful is an understatement, to my surgeon, Dr. Katz., to the young Anesthesiologist, fresh out of medical school I thought, Dr. Carroll, who prepared a checklist for any future anesthesia caregiver in the future, to alert them to my difficult intubation, and the need for a fiberoptic bronchoscope. So I carry this checklist around with me in my wallet to this day and on a USB drive attached to my keychain as a PDF along with other essential medical records.

But most of all I am grateful to the nursing staff that brought me along, and continues to work with me to this day so I can indeed resume my normal life. In fact, with my new "pipes" feeding my heart much needed oxygen, I feel more healthy and productive than I did before. Anyone reading this blog regularly would recognize that as I went on a home repairing spree when we returned from last summer's travels, including painting much of the house myself. Even the scar has pretty much disappeared, although the left part of my chest is still somewhat sensitive because so many nerves were severed and they take a long time to heal.

I did not mean to dwell on the one rotten apple to mark this one year anniversary of my coming back from the nearly dead, but, at the time, she loomed large in my mind. I reported her at the end of my hospital stay so I hope other patients were spared.

My wonderful surgeon, Dr. Katz, is also a gemologist and he has made it a tradition of giving his patients a heart shaped stone specimen of his hobby in their follow up visit, one I had a couple of weeks after getting out of the hospital. You choose one and then he reveals the "story" behind the rock. I choose a very heavy, beautifully polished one.

And the story behind my choice, which turned out to be Hematite, mined in Brazil, is that metaphysically, it is said to be "excellent for calming and relief of stress....a good stone for 'grounding', meditation, dissolution of negativity, and bringing peace and inner happiness," ironically, all my weaknesses, and so I go on hoping it works and grateful for this reprieve. No April fooling.

Labels

I have been retrospectively adding "labels" to my posts, a tedious process, and to use blog-speak, a "gadget" that is not as exacting as a proper index. As a former publisher, the inconsistencies of the labeling process bother me. This is partly my own fault as the labeling was done over several months. Consequently, as an example, President Barack Obama is merely labeled "Obama" while most luminaries are labeled by first and last names, an unintentional gaffe and no disrespect intended. I suppose I assumed we all know who he is. And unfortunately, labels are alphabetized as they appear so first names prevail, an affront to any indexer. But one can scroll over the list fairly quickly although there are more than three hundred labels at this point -- they appear on the left side of the page below "Blog Archive" and "About Me."

Reviewing my four plus years of postings in doing this project I see so much of what I wrote is where the winds blew me and some views have changed. But I intended "Lacunae Musing" as an "everyman's" view of the world going by, so the windblown nature is understandable and the mere passage of time explains some changed views. More painful was to see some repetition, not remembering that a year earlier I had made the same point, perhaps in a different way. Nonetheless, I have not edited or deleted any entries. Let some future generation unwrap this as a buried digital time box. It is what it is.

I expected the blog would mostly cover my diverse interests, but I was somewhat surprised by the number of entries that relate to the economy and politics. Sturm und Drang have characterized those topics during the past few years, so that is no wonder as well. Then there was the incredible open heart surgery I went through last year, a difficult procedure complicated by traumatic intubation so one could say I write this blog on borrowed time, although I feel fine now. Amazing having gone from this:









to this "self portrait" taken during our recent cruise:










As an eclectic blog, "Lacunae Musing" does not have the level of page load activity associated by niche oriented blogs with a dedicated readership. But that's OK by me as I write this mostly as a personal journal and as a creative outlet. Sometimes I wonder if I never did this, and concentrated that same energy in other pursuits, such as the piano or even writing a novel or a play, something I've been tempted to do, perhaps that might be a better use of my time. Or maybe this blog is my excuse for not doing something even more challenging. One will never know unless I find the path to an alternative universe.

However, while writing this blog, I did manage to dramatize four Raymond Carver short stories which I entitled When We Talk About Carver. This consists of dramatic readings of "Want to See Something?" and "Gazebo," each preceding a play adaptation, the former with "Put Yourself in My Shoes" and the latter with "What We Talk About When We Talk About Love" -- perhaps Carver's best known story. As the production requires only two male and two female actors, I thought it would be ideal for smaller theater companies. This required getting permission from the author's estate and the approval (with revisions) of the author's widow, Tess Gallagher, which was finally successful. But my quest to place the play, even for a reading, has come to naught, and it is a lesson learned about how the system "works" (publishing in my days also had its "system" equally difficult to crack). I had naively believed that Carver, as one of the 20th century's greatest short story writers, and my painstaking attempt to use his exact words in the adaptation, would ensure, at least, a placement with a knowledgeable but small non-profit theatre. That is not how it works, and so I can imagine what the outcome might be if I was the author of a play rather than merely the adapter of a writer of Carver's prominence. It is disheartening, but a learning experience. But learning even with disappointing results is better than standing still.

Also, I've managed to keep up with my musical interests, working on several musical programs as I am a volunteer pianist at a local rehab center as well as at a retirement home. The latter gig is particularly fulfilling as I prepare specific programs, my first being the music made famous by Frank Sinatra, followed by one focused on the works of George Gershwin. The Gershwin program was challenging as it required a solid hour of playing his wonderful melodies, including those from Porgy and Bess which are among my Gershwin favorites. I'm now preparing programs by Rogers and Hammerstein (my next), to be followed by an all Steven Sondheim program, and finally a "British / French Invasion of Broadway" program, works by Andrew Lloyd Webber and Claude-Michel Schönberg.

So, "Lacunae Musing" continues to be one of many pursuits, and managing its time requirements is a constant battle. Consequently ,when I started this, I consciously turned off the comments feature of most blogs. However, an email address is included in the "about me" section, so there is a way for people to contact me and I've received many emails over the years and responded to all.

I integrated a "statcounter" about a year so I have a rough estimate that there have been almost 20,000 "hits" since the beginning, most of those from Google phrase searches but almost an equal number from searches of Google Images as I have hundreds of photos in the blog. Unfortunately, BlogSpot is not very user friendly for photographs. I would have carried more otherwise. And there are mysterious inconsistencies with photographs in the blog. Some can be easily enlarged by clicking onto it, and others cannot, even though I treat all work on photographs the same way.

It's been an interesting journey and now with the label "index" I can see the breadth and the focus (or lack of) more clearly. Whether you are a return visitor, or happened to just land here, I hope you find it useful or interesting. I doubt whether I will be able to keep up the pace of writing as I don't want to repeat much of the family history and I might take a little more time to smell the roses, but with the political season heating up, there will be unavoidable fodder for writing. Then, too, there will be more theater, the books I'll be reading, and future travel, whatever suits my fancy. Truly an eclectic journey, one person's views and experiences. Hopefully, it has some relevancy in the real world.

While writing this entry we had a rare concurrent visit of both our sons, our oldest, Chris, celebrating a birthday and so we went to one of our favorite local restaurants, Captain Charlie's Reef Grill. This is a down to earth, funky, lively restaurant with some of the best and most imaginative fish dishes anywhere. One can make a meal of the appetizers, each a unique creation. Part of the fun is even waiting for a table outside in the balmy Florida night. They don't take reservations. They don't have to. People will eagerly wait. We went on a Saturday night, happily passing the one hour wait time sitting on the outside chairs, while others were waiting in a separate bar they maintain a few doors down in the unassuming Juno Beach strip mall where the restaurant is located. The waiters and waitresses have been there forever and they've become old friends. It is a place to see and be seen and the desserts are fabulous such as their chocolate mousse b-day cake!

Widow Maker Redux

There is a reason I've been silent so long. In fact, I am lucky to be around to resume the story I wrote last November when I described my silent encounter with the "Widow Maker" artery. The link gives the detail, but briefly I unknowingly had a 99% blockage in the infamous Widow Maker's artery, the LAD. If it were not for the fact that I regularly exercise, the problem would have gone unnoticed, and indeed my case would have resulted in another widow.

At that time, a cardiac catheterization revealed the blockage and I was given the option of less invasive three kissing stents vs. open heart surgery. Naturally, given the choice between the intrusive bypass, the possible complications, and the long recovery, I choose the path of least resistance. After all, couldn't I undergo the more invasive option if the stents didn't work?

Following that procedure, I began a cardiovascular rehab program, which consisted of 36 sessions. Once again exercise saved my life. I was on my 33rd session when I started to feel some burning sensation in my chest after about 15 minutes on the treadmill (I was doing 30 minutes at 3.8 mph). It would generally pass and I rationalized it was gas, but, here is the value of such programs (one that may become vulnerable to cuts in Medicare): the extraordinarily caring cardio nurses on duty reported it to my cardiologist who called me in for a nuclear stress test. I got through the test, so I went about my business again waiting for results the following week.

In fact, immediately afterwards, boating friends of ours from Connecticut, Cathy and John, visited us and over the next four days we took our small boat out to watch the moonrise over Singer Island, ran the boat up to Jupiter the next day to the funky, fun, Guanabanas Tiki Bar and Restaurant where we could tie up at their splintery old docks and enjoy a little bit of the Caribbean right here in Palm Beach County.

The following day we went to Peanut Island, our favorite destination on our boat, watching Tiger Wood's yacht, 'Privacy' (Tiger put the boat up for sale recently if you have a spare $20 million or so and can afford the crew and maintenance) glide by as Ann and company played Scrabble on the beach. We enjoyed lunch al fresco and later barbecued dinner and left as the sun slowly set.
A possible negative report on the stress test was the farthest thing from my mind, and I went about my normal activities as usual. In retrospect, our friends' visit could not have come at a better time.........the calm before the storm. Life as usual.

My follow up appointment with my cardiologist was the day after they left. Apparently, the stress test, combined with the burning symptoms when exercising, called for another catheterization and, as was explained to me, the sooner the better. The following Monday, March 28, I went into the hospital and had the catheterization expecting, at worst, Restenosis, which usually happens within 3-6 months after stent placement and I was still in that time frame from my previous procedure. I thought I would wake up to still another stent or a treatment of intra-coronary radiation (brachytherapy).

Wishful thinking. I was told my Widow Maker was now more than 90% blocked again (turned out later to be 100%) with another artery 50% and I would need dual bypass open heart surgery. There is a delightful acronym for this surgery as it is sometimes called: CABG ("cabbage"). I was to become a cabbage patient. Luckily for me, one of the gifted thoracic surgeons in the area, Dr. Arthur Katz, was available for the task, and also that I was at the Palm Beach Gardens hospital which is a leading heart hospital.

First order of business was to get as much as possible of the blood thinning Plavix out of my system before surgery. I had been on the drug since my first stent more than six years ago. However, knowing that I had such extensive blockage in the LAD (the LAD coronary artery supplies a very large part of the heart muscle) made it a judgment call of how long we could wait. The surgery was scheduled for March 31 but after a blood test, it was delayed one more day (April Fool's day). Our son flew in from Tokyo (where he had been during the earthquake, but that is another story) to be with me and my wife. His presence made all the difference to Ann who bore the brunt of seeing my struggle and trying to communicate status reports to friends and family via email and phone. My older son, Chris, could not be here but Ann kept in constant touch with him.

Dr. Katz specializes in surgery without the use of a heart lung machine (off-pump, it's called), something I was grateful for as I have heard about cognitive recovery and other issues resulting from that. But as it turned out, my operation was anything but routine. First, endotracheal intubation (the process of placing a breathing tube to protect my airway and control breathing during the administration of general anesthetic), became very difficult because of various anatomical issues unique to me. A fiberoptic bronchoscope had to be used after several unsuccessful attempts at direct larngoscopy and glidescope.

Surgery went well initially, using an internal mammary artery and another artery from my left leg, but then there was increasing difficulty controlling bleeding. I had a number of transfusions. In fact, after my sternum was wired and the chest stapled, there were further signs of internal bleeding so for the first time in recent memory, Dr. Katz had to reassemble his OR team and go back into the wound. This carries a risk of course and it is why surgery is as much an art as it is a science.

Thankfully, he was able to control the bleeding at this point, but I had been through the wringer and back again, and had to have half of my body's blood replaced. As I had so much anesthesia, my recovery was to be equally slow and for four days I had that breathing tube down my throat as I went in and out of consciousness. My throat had been lacerated and was now excessively swollen. Waiting for my throat to return to normal, mittens had to be put on my hands so I wouldn't grab the tube when I had brief borderline awareness. Ann said during those moments I was waving my arms, gesturing with my boxing glove hands and giving everyone the fish eye. No wonder.

When I finally came to, I was in intensive cardiac care, pretty much unable to move, and having been unconscious for four days, would now probably be awake for at least two days. Those nights were the most difficult, not being able to move much, trying to get into a comfortable position, forced to lie on my back. I could hear almost every precious heart beat and sometimes the creaking of my sternum which was wired together. Deep into those nights you are left with your thoughts and fears, regrets and hopes.

I could operate a TV on the wall with a remote. It is not possible to realize how bad late night TV is until I became dependent on watching it all night, unable to sleep. I thought it ironic that juxtaposed to my surgery was all the rhetoric on the news shows about shutting down the government because of the lack of a budget compromise, all the posturing and huffing and puffing by the wolves in Washington, the propaganda about "entitlements" and the inexplicable inability of rolling back some of the Bush tax cuts as one part of dealing with the growing deficit. A subject for another entry, but, this is what I listened to as I was personally benefitting from an excellent healthcare system and no doubt a very expensive one, the very one some of our politicians would like to turn over to the insurance companies.

There is no way to describe everything that had to be done to me and for me to pull through, but I had asked my son to take a picture of me in recovery, thinking I might want to post it if I survived the operation. Warning, it is not a pleasant sight, but I include this at the end of this entry. It puts a "face" on Medicare. In spite of all of the shortcomings of the program, as one of the most civilized countries in the world, such care must be available to all. And of course, throughout all of my 15 days and nights lying in that hospital bed, I was looked after by a revolving crew of highly trained nurses who literarily kept me alive changing vital fluids, making me as comfortable as possible with all the tubes and apparatus attached to me and using all their skills and experience to help me survive my arduous surgery. There is no way I could ever thank them properly enough for their dedication and professionalism.

My breathing tube was gone by the time I came to. The third chest drain was yanked out (yanked is the correct word) by Dr. Katz as he diverted my attention to a discussion of where I grew up and my familiarity with Jahn's, a favorite teenage hang-out in Richmond Hill. Strange to be talking about Jahn's "kitchen sink" some fifty years later while a chest drain is being removed. Finally my urinary catheter was removed as well.

Another complication was a sudden spike in fever when I finally got to the regular cardiac unit, so for the next two days I was tied to massive intravenous antibiotics. No one could explain this spike which disappeared as quickly as it appeared other than it being somewhat par for the course.

So now I have been home for a little over a week and thanks again to Medicare, have been closely monitored by an attentive nurse and physical therapist putting me through the paces in the house. I now have follow-up Doctor appointments and have been given the green light to return to cardio rehab next week. While bypass surgery has relatively good prognosis, the fact that I had complications, new blockages, etc., results in some anxiety. I eat a healthy diet, exercise, have always been active, but as I said in my prior entry on the Widow Maker, hereditary factors seem to preside over everything. Will my therapy and new medications offset this deficit? That is the hope.

To friends and family who might be reading this, thank you for all your heartfelt support, for me, and my wife who has been valiant through all of this. Ann was calling, emailing everyone, coming home from the hospital near exhaustion. Her last email after my second (no, actually third) operation in a week is typical of the kind of attention she gave to everyone, in spite of the late hours she returned from the hospital:

Dear Friends and Family,
It's been a day from hell. All I can say is thank goodness Jonathan was here with me, or I would have lost my mind. In short, Bob was bleeding profusely during and after the operation this morning for the double bypass. We saw him very briefly in the critical care recovery room with a million tubes coming in and out. We were home less than an hour planning to return over the next visiting period when Bob's Surgeon, Dr. Katz, called and said he was going back in again, Bob was still oozing and he was reassembling his OR team. That meant cutting his chest open over the fresh stitches, undoing the wiring on the sternum, breaking it again and taking another look.

I thought Jon and I were going to pass out. Once we started reading all the literature on this procedure and all the risks involved, we were totally freaked. When it was finally over, we saw the Dr. and spent 20 minutes discussing everything.

The good news now is that Bob is stable. No profuse bleeding, holding his own. They can't take out the breathing tube yet, however, because he is still in critical care and because he may have suffered lacerations in his throat when it was originally inserted (with great difficulty) and they're waiting for an ENT specialist to examine him.

To update, Jon and I have just returned from our third brief visit at 9:00 this evening and although we are both bleary eyed, I wanted to send this quick, and I hope reassuring, note to you. He is completely stable, but still heavily sedated and was not aware of our presence. He has a dedicated nurse with him all night who is a gem. The ENT Physician had not arrived but was expected at any minute. His heart is strong now, the lungs are clear, all his other vital signs are good and we are confident that he will make a full recovery. .