The Journey of Repair and Recovery – Pretty Easy

Quick Note

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 after surgery.

Cheers, Tom

Clean-shaven and loose on the street,   
3 days after surgery to correct
Mitral Valve Prolapse (MVP) ®

The Journey

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 it.

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 back anyway?

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. Astounding!

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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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