This past September, my eighteen-year-old daughter Cara wrote in a college essay, "We all know there are some big moments that change our lives … those moments are usually the ones that define us as people, and leave the longest impression on our lives and character."
She was writing about my heart valve surgery that took place on August 8th 2004, just over four years ago. I had a congenital valve defect that I knew about since I was about ten years old. The murmur, which was occasionally commented on by physicians that I visited over the years, didn’t affect me, or so I thought. Sometimes, when I would really overexert, such as on a 20-mile-plus mountain bike ride, I would get a cold clammy feeling in my chest that would go away when I backed off. I thought that this was merely normal symptoms of overexertion that anyone doing what I happened to be doing at the time might experience.
In 2002 I changed to a new primary care physician. Dr. Richard Tedesco noticed my murmur right away. I explained to him that I knew all about it, and that it didn’t bother me, but he sent me to a cardiologist to have it examined anyway. I felt put out by this inconvenience. No other doctor had done this, and many doctors over the years never even mentioned on my murmur. The cardiologist, Dr. Carl Fier, explained that I had a bicuspid aortic valve instead of the normal tricuspid and my valve didn’t close properly. This resulted in a mild to moderate murmur. He said that I should have an annual echocardiogram because this type of valve defect could potentially deteriorate as I aged.
When I returned for my follow-up echo a year later, no deterioration was noted, so I went on my merry way. That summer I was working on a project for the Centers for Disease Control that took me to Seattle and Chicago. A day or two after returning from that trip, I found myself playing a game of doubles racquetball at the Executive Health Club, where I had been a member for better than 25 years. Although I worked out regularly—meaning at least once a week—I wasn’t in great shape. I was about sixty pounds overweight, and when I did exercise I would push myself to the limit and often get that clammy feeling in my chest. On this particular night—Thursday August 5th 2004 to be precise—I had that feeling. I was playing doubles and couldn’t back off because it would have let my partner down. When the game was finished, everyone wanted to play another, so I kept going even though the symptoms in my chest were telling me that I shouldn’t. In all, I believe that we played about three hours of racquetball that night. When we were done, I showered and went home, still feeling poorly. I stayed home from work the next day (Friday). I didn’t improve that day or the following evening. My wife Mary-Jo was getting worried and impatient. I assured her that it was nothing (although I could hear some weird gurgling noises in my chest—a fact that I did not share).
Finally on Saturday morning Mary-Jo had enough. She piled me into her car and took me to the Elliot Hospital emergency room where I was poked, prodded and x-rayed. The diagnosis was bacterial pneumonia. Thankfully, they didn’t just give me antibiotics and send me home; they admitted me and kept me overnight. The following morning Dr. Fier showed up in my room with a portable echocardiogram machine. He told me that he looked at my chest x-ray and agreed with the diagnosis of bacterial pneumonia, but he wanted to do the echo to "rule out the valve."
He attached a variety of sensors to my chest and gelled up the transducer of the echocardiogram machine. Within seconds of acquiring an image of my aortic valve on the computer screen he exclaimed, “The valve is ruptured! We need to operate.”
"When?" I asked.
"Today, as soon as possible," he replied.
"Why today?" said I.
"Because you won’t survive the weekend," he answered.
That got my attention—especially since it was already Sunday morning.
Dr. Fier left the room briefly to make a phone call. When he returned he informed me that he had spoken to a Dr. Westbrook at CMC. I would be transferred there and would undergo emergency valve replacement surgery that afternoon. I asked what this would mean for my life. Dr. Fier paused thoughtfully for a few seconds then said, "You will be cured."
The next hour or so was a whirlwind of activity. I was stuck with IVs and had a Foley catheter inserted (not fun). I tried without success to contact Mary-Jo, but did get in touch with my brother-in-law, Mike. I was wheeled down to an operating room at the Elliot where I underwent arterial catheterization that not only confirmed the diagnosis, but provided some welcomed news as well.
"You have no coronary artery disease, which is a great thing to know at age 50," Dr. Fier explained. I was happy to receive the good news and was actually quite fascinated at seeing all the veins and arteries of my heart on the computer monitor in front of me. Somehow, Mary-Jo and the kids (Cara and Mia) arrived at the Elliot before I was loaded into an ambulance and driven across the city. I had a whole list of instructions to give her dealing with things at work that at the time seemed important. The ambulance ride across town seemed very short. All too soon I was being unloaded and wheeled into the Catholic Medical Center OR.
Once anesthetized, I was incised, my sternum was split with a power tool, and my ribs were forced apart and clamped open. I was placed on a heart-lung machine and my heart was stopped. My aorta was sliced open and the defective valve was cut out. In its place a St. Jude Medical synthetic valve was sewn. With this new bionic valve in place, I was taken off the heart-lung machine and my heart was restarted. My rib cage was closed and wired back together (a bit crooked), and I was sewn up with a few wires and drain tubes temporarily protruding out of my abdomen.
The operation itself lasted about three hours and apparently went well, although I had a pretty rough 24 hours afterward with bad reactions to some of the medications administered, and fears of infection. My first recollection after the surgery was of being surrounded by friends and family in the cardiac intensive care room. It was Tuesday afternoon. Present were Mary-Jo, Cara and Mia, brother Ron, sister Jill and her kids, my mother, Janet and Michael Maher, as well as nurses Peggy Letson and Michelle Zorawowicz. Jill was busy ripping pages off of the day calendar so that I would think that I was in an extended coma. I managed to extend “the finger” at her, which drew a great deal of relieved laughter. Apparently that was the first sign that I had returned to their world. Although I have no recollection of the time between "put under" on Sunday and "coming to" on Tuesday, I did recognize the terrible ordeal that I put my family through and apologized profusely
I spent a full week in the hospital after the operation. Taking a single step took every ounce of strength that I could muster. Sleep was nearly impossible due to the frequent interruptions for medication, the discomfort from the broken sternum, and the nightmares brought on by the painkillers. When I arrived home I was a physical and emotional wreck. I hardly had the stamina to make it from the car to the front door.
I was given an exercise schedule that began with walking for four minutes on the first day, and increasing by a minute each day until I could walk for 20 minutes. This sounds like nothing, but was painfully difficult at the beginning, and I doubted if I would ever manage the 20-minute goal. But little by little, inch-by-inch, I began to recover. A few weeks after returning home I enrolled in a six-week cardiac rehab program at the Elliot Hospital. This began with easy walking on the treadmill, stationary biking, light rowing, and some easy calisthenics, all performed while wired up to an electrocardiogram machine. As the days went by, I could feel my strength gradually returning. With a few sessions left in the course, I asked Janet Reilly, the program manager, if I could try running on the treadmill. My EKG looked good, so we gave it a shot. We turned the mill up to 5 MPH and I broke into a trot for a few minutes. I was elated.
After "graduation" I continued my workouts back at the Executive Health Club. I ran on the treadmill, lifted weights and swam. I made it a point to eat healthier and my weight dropped. Each day I became stronger and more fit, and added new routines, such as spinning, to my repertoire of activities. What started out as recuperation transformed into an entirely new outlook on life. In the spring of 2006, I entered my first 5-K road race in more than 20 years. I followed that up less than a week later with a 12-K. I somehow stopped thinking of myself as a recovering heart patient, and became an athlete. The culmination of this transformation was entering, training for and finishing my first marathon, the 2007 Walt Disney World Marathon.
That was more than a year ago. Since then I have competed in numerous races including half-marathons, relays, triathlons and a two other marathons, including the Boston Marathon. I am headed to Ireland this week to run the Dublin Marathon on October 27th and next January I will be competing in the Goofy Challenge, a back-to-back half marathon and full marathon, again at Walt Disney World.
Cara accompanied me to Disney for my first marathon and we celebrated my "moment" together. Every journey does indeed start with a single step. I hope that my journey can inspire others to take that first painful step.
