The Journey of Repair and Recovery – Pretty Easy
I’m out of the hospital. I'm feeling great, and couldn’t be doing any better. This
is amazing. Someone is cutting and sewing in your heart one day and 3 days later
you’re out walking on the street. I was out of the hospital by noon Friday and Friday
night Jan and I had a normal dinner at an Italian restaurant in Greenville, NC. If
you'd seen us, you'd think it was just another day. I don't even get a Handicapped
Parking space. Except for taking care that I don't stress the muscles on my right
chest, I'm the same as before and feeling great. Going home August 12th, one week
Clean-shaven and loose on the street,
3 days after surgery to correct
Prolapse (MVP) ®
Surgeons seem to get their work done before most of us are even out of bed. You show
up at 5:15 to start getting prepped. Scrub you down, talk to the anesthesiologist
and ZZzzzz… Trouble is, they told Jan later that I was blabbering on, asking all
sorts of questions about what they would be doing and that they had shown me the
da Vinci machine. Well, they must have erased that part of my memory because I don’t
remember anything after shaking hands with the anesthesiologist. Now that I think
of it, I’ll have to tell my daughters not to date any anesthesiologists.
The surgery started out with a bit of a surprise. There was calcium on my valve that
was unexpected. I imagine a tough white coating on this flappy valve. It seems to
accumulate where there isn’t sufficient flow of the blood through a part that is
always expected to have blood flowing through it, like in my case. I suppose that
over time it gathers on the tissue the way calcite leaches out of the water dripping
through the aquifers of Texas to make stalactites and stalagmites. Mineral-rich water
makes beautiful underground cave creations at a rate of ¼" every 100,000 years. However,
calcium in the heart clutters things up in a year or two and doesn’t make for a very
pliable valve, so Dr. Chitwood had to spend 30 extra minutes removing the calcium
before he could start his real work.
The good news was that it wasn’t a particular problem, just something to work through.
The main repair was completed in much the way I described earlier, trimming up the
existing tissue and reallocating chordae, and they put me back together. I have a
couple of GoreTex chordae in my heart now. Yes, this name may sound like the material
of your favorite windbreaker, but apparently it is a very flexible long-lasting material
that could show up everywhere solving mankind’s problems. I don’t know who owns the
patent on GoreTex but that might be a good family to marry into.
Apparently on my day of surgery there were some interested surgeons from Johns Hopkins
University who were watching the operation. Again, Dr. Chitwood seems to be leading
the medical community in this computer-assisted minimally-invasive mitral valve repair
work and if others want to learn to perform it, they can come here and experience
My wife and kids had come to Greenville so they had waited around to see how I made
it. After I was through, Dr. Chitwood came out and spent as long as they needed describing
the procedure he had performed and the issues that came up and how they were resolved.
He’s very interested in his work and seems happy to explain it to you – a good complement
to a guy like me who wants to understand everything. It was a good thing the kids
were here, though they may not know it.
Jan apparently was a wreck during my surgery. She’s the one that needed the drugs
– or the kids who had to sit with her. When the 11:30 time rolled by and there was
no evidence that I was through surgery, the lioness started her pacing. As it dragged
on for another hour she apparently was pretty bonkers. This is why I’m sure there
are steel-reinforced concrete walls between the patients’ waiting room and the operating
theatre. Can you imagine the questions of "well, did you try this?", "Bill says you
should start at the top", and "why don’t I call somebody about this?" I’ll bet her
blood pressure was off the chart. But the kids are kids and kept her loose enough
to avoid getting arrested.
But I also found out that Jan was herself for much of the day. By the time I spent
any time with her a couple days later, she had gotten the life story on everyone
in the waiting room and their patients. He had a quadruple by-pass. They're from
Greenville. She works in college. His father died at age 41. That woman has three
kids. He has had 2 heart attacks since he turned 37. Hers was a re-work. Oh, I don't
know who that person is…
This sort of friendliness makes the husband and children cringe and roll eyes, but
when laying in recovery it actually makes quite interesting conversation. Then as
I'd wander the halls with Jan, we'd stop in to visit the patients and families I'd
heard so much about. You'd have thought it was family reunion time.
They only let 2 visitors into intensive care for :15 every 2 hours, so there were
only limited times I could be visited after surgery. Done with surgery about noon,
apparently I was first seen looking like some sort of Eskimo. I haven’t got too good
a description of this but maybe they had me in a puffy "warming" suit as I came out
of surgery. Only a couple of the kids saw me in it and two hours later when they’d
snuck a camera into the Intensive Care Unit (ICU) I was no longer dressed like that.
However, the nurses had carefully described to the kids all the tubes and wires hooked
up to their Dad. Barton listened intently and relayed the info to Jan and Jessica.
I was still in the drugs but the kids kindly took a photo of me anyway. By 6 o’clock
they could sort of get my attention but it was really nearly 8 at night before I
could hold a decent conversation with anyone. That first cup of ice they give you
after anesthesia is so good, and then later when they bring you some Welch's grape
juice you’re just over the moon!
The next morning in ICU they brought me my first real food. The note typed at the
top of the delivery slip wished me a very Happy Birthday (the nurses seemed quite
aware of this event). I had been talking to the nurses ahead of time and they brought
me just what I had asked for: scrambled eggs, hash browns, bacon, a biscuit with
strawberry jam, and whole milk. I had to laugh. You may think this was the hospital’s
way of saying "y’all come back real soon" but eating habits were not a contributing
factor to my heart problem, so I wasn’t on a restricted diet. Ya gotta love the South.
As I was in ICU, my room faced one of those doors where they punch the button, there's
a ca-chunk and the doors automatically open up and gurneys are rushed in with doctors
swarming around. As I laid there in a daze I’d hear that door open and look up and
here was my family bouncing up and down making faces at me and acting like clowns.
It was quite a hoot.
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I have been real lucky and have had no soreness, inflammation, or infection at any
incision points, which thrills me. On me they didn’t really need the pacemaker, but
on some people they may need it to start the heart or get it to continue beating
in proper rhythm. That’s one of the main things they watch you for: is his heart
beating correctly over a period of time, some active, some sleeping, some watching
the paint dry. Some friends had given me some books to read but I found I had to
be careful with the funnier ones because laughing uncontrollably isn’t the best form
of pain management for the chest area.
Shortly after getting out of intensive care, a nurse took me for a walk and made
sure I wasn’t falling down and from then on I could walk around the nurses stations
to my heart’s content (takes on a different meaning there). That was a relief. I’m
not a sitting kind of guy. Even on a Caribbean beach I can’t just lay there no matter
how pretty the girls..I mean, the beach.
Jan had to drive the kids back to the Raleigh airport 2 hours away so they could
get back to whatever teenagers do when their parents are out of state. It wasn’t
as fun without the kids around any more or while Jan was gone for 4 hours, but then
I realized the situation of the poor guy in the next room. He’d had a quadruple bypass,
but his wife had to work while he was in recovery. Having people around you can really
help keep the spirit going. Nurses really are great but they have to split their
time and there’s nothing like some personal love.
I made quick progress myself. Being one of the younger patients around and in good
general health goes a long way in getting through these things. With some pain medication,
I was just fine. Not happy-these-drugs-are-far-out kind of fine, but able to walk,
talk, think, and do what I want. I’d doze off some times, but I wasn’t weak, didn’t
feel dizzy or unstable, and didn’t get weary late in the day. I could eat my food
(it was actually rather good – no, Mom never could get me to eat peas), I read newspapers
and books, watched Schwarzenegger try to whip Gary Coleman in politics, and tried
to make the nurses chuckle (some kids never grow up).
But I wasn’t uncomfortable. A few friends figured out how to call the hospital and
they seemed surprised that I answered the phone. I really felt normal. You might
think the IV’s or pills they give you would have grumpy or sleepy side effects but
I didn’t experience any. Bolstered by a feeling of being alive in a new way, I did
pretty well. The other patients were much more subdued and confined. The doctors
warned me that a later day could be rough, but no such bad day ever really came for
me. I credit my bounce from being in good physical shape and taking a minimally invasive
route where there just wasn’t that much cutting going on on me. My chest was intact,
so there was a ton of healing that wasn't going to be needed, stretching the capabilities
of my body.
It was clear that second day in medium care (2 days after surgery) that I was doing
well. I realized I was about the only patient that was walking the halls. They didn't
want me drifting too far, and you never know what disease ward you might wander down.
Mostly, halls were dim and rooms hushed. One nurse mused that I was making the other
patients jealous with my rounds. My wife would often pester around behind me with
a roll of surgical tape telling me my hiney was showing. Hey, you put a guy in a
dress, he might not look so good. Who designed those things with the flap in the
By the Friday they were able to let me leave the hospital. I seemed to be in good
shape and there wasn’t anything Jan and I couldn’t do ourselves at this point. We
went out Friday night and ate dinner in a restaurant, and rented a few DVDs to watch
in the hotel.
On Monday we returned for a final checkout by the doctor, which was to make sure
we understood our instructions as much as anything else. I was cleared to fly and
return to Austin and care for myself, a mere week after flying in for the operation.
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One time, the girls stood there, stoic and at full attention in a sort of "Men in
Black" pose for the entire time the doors were swinging open and shut – because they
knew I’d get a kick out of that. The good news is that the Starnes sense of humor
has passed to the next generation. Keep an eye on Julia.
There wasn’t really a need for me to be in intensive care so long, but there weren’t
any beds in the medium care facility. Someone finally moved out and by noon the day
after surgery I was in medium care. With each passage of time something more came
out of me. They’re draining various parts of you, measuring input and output, watching
for leakage at the incision points, including those inside you. As it was deemed
satisfactory, they’d pull a tube out of you or remove a stitch or something.
I was apparently doing extremely well and so advanced at a good pace. For my entire
stay, they had an EKG machine hooked up, making sure my heart beat in order, and
a blood-oxygen monitor on my finger probably designed by my brother-in-law making
sure I was getting air. Julia referred to this as my ET finger since it had a red-glowing
LED on it.
They stop the heart by first chilling it greatly, like when the kid falls into the
not-so-frozen pond and can be recovered an hour later. Then I guess they drain it
after they’ve got most of your body on the heart-lung machine. A potassium citrate
solution is run through the coronary vessels to quiet the heart from beating. The
heart-lung machine pulls blood from a vein in the groin through a cannula, which
seems to be a tube they attach to you (when the North Carolina nurses said the word
"cannula", I kept thinking they said the "camera" goes there – they have an accent
that we don’t have in Texas). The refreshed blood is pumped back into your neck (carotid
artery, I think).
I didn’t figure out how they closed off the heart from the circulating blood. I imagine
the red rag sticking out of a gas tank shoved in there, but it’s probably a little
cleaner than that. At the end, the heart may start beating on its own after warming
and re-flushing with blood (it appears that mine started on its own), but it often
takes a tickle from a pacemaker. On some people the pacemaker is used a week or more
to keep the different sections of the heart pulsing in perfect rhythm. They monitor
this carefully before you leave the hospital.
Indeed they had made only two small holes in my right side for getting the tools
(the robotic arms) to my heart. There is one 2" cut under my right pect. [Now, the
doctors and nurses keep saying "right breast" but everyone knows that men don’t have
breasts. Breasts only appear on women. They may be there for men (in carefully controlled
circumstances) but men don't have breasts. So I’m going to use the word "pect" rather
than breast when referring to the manly pectoral muscles, the mere illusion of which
makes the blood drain rapidly from Jan’s head leading her to unladylike behavior.]
The camera and some utensils were put in the larger slit and fed to the surgery location.
Some drain tubes from around the heart were placed, as were the pacemaker wires.
Pulling out the drain tubes sounds kind of gross but it didn’t particularly hurt.
However, I don’t know what "purse string" stitches are but when they tension those
babies up, it’ll have your full attention. Ultimately, with the drain tubes out,
my chest felt better. The pacemaker wires look like two of the 26 gauge wires the
telephone man used to wrap up in the little box on the kitchen wall, except that
these stick out of your chest.
It was really weird when they later just grabbed these and pulled them out of your
chest, but it didn’t hurt or anything. One second they’re laying in your heart muscle
as it beats and the next they’re sitting in the trash. Absolutely amazing. You have
to lay low for an hour to make sure your heart doesn’t "freak" after pulling these
(I’m not sure if the doctor wore any anti-static straps before he pulled the wires.)
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<See Time Line, farther below>
Date in 2003
weeks from surgery
Everything fine. Health believed to be 100%
Fall & cut chin, Doctors at hospital are disturbed by seriousness of heart murmur
Get Full Echocardiogram
Cardiologist strongly suspects Mitral Valve Prolapse.
TEE shows extensive regurgitation.
Cardiologist says "Need MVP surgery by year end"
Second opinion confirms MVP severity and calibrates the robotic minimally-invasive
Heart Catheterization shows arteries to be clear
Ride bicycle 2 hours, 20+ miles, mostly on trails
Surgery day; MVP repair, robotically-assisted, minimally-invasive
East Carolina University,
Released from Hospital (3rd day)
Last pain medicine needed
Return to work
Ride bicycle to work
Bicycle ride of 10 miles
Bicycle ride of 20 miles
Bicycle ride of 55 miles*
Echo of heart confirms normal size and tight valve operation
* the Annual Texas Hill Country River Region Classic, an organized bike ride including
killer hills through gorgeous rocky, wooded landscape