by Tilda Shalof
Two days later, when my kids tumble off the bus from camp. I take them into my arms – Max, who lets me, and Harry, who pulls away. I am out of breath from simply hugging them. At home, they beg me to play basketball on the driveway, as I used to do, but after two dribbles I’m done, panting and short of breath.
“Are we going to get a puppy, Mom?” they ask. We had talked about getting one this summer, when they got home from camp.
I’m too weak and tired to even answer them, much less entertain the possibility of having a dog in the house and attending to all that that would entail.
I can’t continue like this anymore. I will go forward; I will choose life.
6
ROCK STAR SURGEON
In my new-found state of nearly nirvana, high on this huge epiphany after the cardiac angiogram, I feel confident I can deal with what’s ahead.
Three days after my angiogram, Dr. Drobac calls to tell me he’s referred me to a cardiac surgeon. “Dr. Tirone David. Have you heard of him?”
In my world, who hasn’t? The surgeon with the movie star name and sexy good looks is a rock star! Having him operate on me would be like having Rembrandt paint my portrait or Mozart compose me a symphony, yet I’ve ridden with this legend on hospital elevators and waited with him in the line for coffee at Tim Hortons. We have even discussed patients together. And, yes, from time to time I did wonder whether my defective heart would ever be so lucky as to land in his gifted hands. But it will probably take months to get an appointment and I am adamant that I won’t ask for special treatment. I want to be treated like everyone else and find out if all the dire reports and criticism I hear in the media and testimony from dissatisfied patients will be true for me. I’m hoping to keep my faith in the health care system and I am curious how it will go for me.
Admittedly, my little sociological “experiment” is biased from the get-go by my insider hospital status and privileged demographics – urban-dwelling, English-speaking, middle class, and well educated – all of which will likely garner me quicker, better care. In theory, Canada’s universal health care system provides equitable access and treatment to all, but the reality is that it works more efficiently for those who know how to navigate through it. Yet, despite all the problems and inequities, from what I’ve seen, most people get what they need. We have it pretty good in Canada.
Two days go by, then three, then a week. How long will it take? I am starting to panic. This is unreasonable! Now that I want this surgery, I want it now.
Another day goes by and I’m freaking out. I call Mary to gripe about the excessive wait I’ve been forced to endure and our underfunded, inefficient health care system. As soon as I hang up the phone the red light is flashing. It’s a message from Dr. David’s secretary. Would I like to see Dr. David tomorrow?
Of course.
Next, Dear Reader, I did what anyone in my situation would do: I google-stalked him. It soon confirmed what I already knew – that he’s one of the top cardiac surgeons in the world. I’ve also managed to glean some fascinating nuggets about the man. Dr. Tirone David has been appointed Officer of the Order of Canada, the country’s highest recognition, for his work and innovations in cardiovascular surgery. Born in Brazil, he worked in Africa with the great physician and humanitarian Albert Schweitzer. As a medical student he practised cutting and sewing on leather shoes, training himself to use both of his hands equally so as to be able to work on the heart from any angle and not to waste precious time while the heart is stopped. He specializes in the aortic valve and invented the David Procedure, a way to replace the aortic root while sparing the valve. Patients come from all over the world to be operated on by him. Yet, in one interview, he laments that in Canada, health care is not for sale. “It’s a pity,” he says, “but selling cigarettes, not health care, is what should be banned.” Years ago, he could have gone to the United States and made millions but chose to stay here and make a few fewer millions. He espouses the benefits of a healthy love life, claiming that sex is good exercise.
I hope to get back on that medical regimen one day.
For years, I’ve heard the buzz about Tirone David’s stellar reputation, but if I did have any doubts, I’ve heard the skinny from the most reliable sources, the nurses who’ve worked with him. They dish about all the doctors and know which surgeons have the lowest infection rates and complications, whose patients do well, and who they’d choose for themselves or a family member.
I call Meera, my CV nurse friend. “Tirone David is brilliant, a genius. He’s more than a doctor – he’s an artist.” Then she said something I hadn’t even thought to be concerned about. “He won’t open you up any farther than necessary. He’ll minimize your scar and close your chest himself, not leave it to a junior. He does that, especially for women because he knows the importance of cleavage,” she said.
Who cares about a scar? I want to live!
There’s just one thing that my cardiologist mentioned in passing that does concern me: Dr. David recently broke his arm. He might not be able to do my surgery.
Before going to the appointment, I put extra effort into preparing myself. Since there’s no time for a new wardrobe and an extreme makeover, I work with what I’ve got. A new outfit, high heels, and makeup – I’m no femme fatale, but this is as good as it gets.
It’s easy for me to find my way to Dr. David’s office on the sixth floor, but when I’m at work, not a day goes by when I’m not stopped in the lobby or hallway by a worried-looking patient or lost visitor, a slip of paper in their hand, asking how to get to the X-ray department or where to get a drink of water. Hospitals are labyrinthine and confusing – this one especially. They’re like huge jigsaw puzzles with interlocking pieces that are constantly being refigured and rearranged as old wings are torn down and new additions created. A radiology department today becomes a sushi bar tomorrow. The medical records department shrinks to nothing as patient charts go online, freeing up space for new dialysis education classrooms. Overnight, a coffee shop morphs into a patient and family information centre. Over the years, I’ve watched as this place continues to grow and expand, seemingly in constant flux, always being pushed to the limit of its capacity.
In the beige-hued, no-frills waiting area, I settle in to wait and check out the crowd. One thing I know for sure is that if you talk to anybody in a hospital waiting room, you’ll gladly take your thing over theirs. I chat with a single mother of two young kids. She’s in end-stage heart failure and only a heart transplant will save her. There’s a heavy-set man on an oxygen tank and an Orthodox Jewish couple, he in a black suit and she in drab clothes, who sit off by themselves, praying fervently, both looking pale and unwell – and others.
I sit, thinking about hearts. Not red Valentines or hearts o’gold, nor my own heart for a change, but the thing itself. It’s the one part of the body that seems animated. If you have ever seen an open chest, you can see the heart do its work, moving blood. Pump, swoosh, pump. They don’t call it a muscle for nothing!
To me, the mythology of the heart as an emotional centre doesn’t make sense. My brain controls my emotions and the heart seems more of an athlete than a lover. The kidney is also a workhorse – a powerhouse, in fact – but it doesn’t get the attention the heart does. There’s the strong, silent liver, working modestly behind the scenes, staying away from the limelight. It rarely kicks up a fuss unless pushed to the limit, but when that happens, all hell breaks loose. The liver is every bit as formidable as the workaholic heart or the mysterious brain, but there aren’t as many gala balls to fundraise for it. No offence to gut specialists, pee-pee docs, or skin-heads (gastroenterologists, urologists, dermatologists or plastic surgeons), but their organs don’t have the same cachet as the heart. The heart steals the show. Yet, I’ve seen cardiac surgery and the reality is a technical, cut-and-paste job. It’s a mechanical repair of something sophisticated, a simple fix of something complicated.
I recall something else Meera told me about Dr. Da
vid. She once attended a lecture he gave and a friend of hers asked if cutting into the heart made him feel like God. It didn’t make him feel like God, he said, but made him believe in God. The friend was satisfied with the requisite humility his answer implied. “He knows he’s God’s servant.”
But when you consider what they do on a daily basis, it’s understandable why some of these surgeons have a God complex. It’s preposterous, presumptuous what they do. They stop the heart so that they can do their work. How certain they have to be to have the nerve to slice into a sleeping person’s innocent body! When you think of the challenge of surgery, then add a public who wants everything immediately, will jump on any mistake, and is constantly evaluating their performance – we should be glad that there are enough of them willing to take on this work at all. No wonder some have huge egos, throw tantrums, and act like divas. Inexcusable but understandable.
In the hospital, there’s always waiting to be done. I am trying to see waiting as an opportunity to practise staying in the moment and being calm, readying myself for what’s ahead. It’s a reprieve, a time to rest and breathe. One thing I know about waiting in a hospital, it doesn’t mean you’re forgotten, though it can feel that way. It’s a reminder that others are sicker. I have seen the look of dismay, even fury, on families’ faces when I’ve explained that my delay in getting to them was because I was taking care of someone else. Their look says it all: Why am I supposed to care about the others? Only my loved one matters. Yes, but we should care, or at least try to. It’s probably too much to ask on an individual basis, but as a society, it’s worth considering from time to time. We can’t have everything right now. We all need to learn to relax more. I’m still working on this.
The secretary comes out to the waiting room to explain that Dr. David had to attend to an emergency in the operating room but will return shortly.
Waiting is always so much easier when you know the reason.
As I settle in to do more waiting, I overhear conversations on either side of me. One patient recounts horror stories of her surgery – “Oh, the pain, the depression, the constipation!” The other boasts of her quick recovery. “Went home after four days! Nothing to it.” I move away from all input, good or bad, and take up a seat beside a husband and wife discussing a book they’re reading together about personality types – the Sanguine, the Melancholy, the Phlegmatic, and the Choleric. Perfect white noise distraction for me.
Eventually Dr. David arrives and apologizes to us all for the delay. He’s ready to see patients. The Orthodox couple stands up. The wife adjusts her long skirt and gives a tug to her wig before going in. She’s heavy-set but walks briskly. He’s anemically thin and moves sluggishly. I can’t tell which of the two is the patient, but seeing how unwell they look is a reminder that it’s best to go into surgery in tiptop shape. The fitter, stronger, leaner you are, the fewer the complications, the better the outcome, the faster the recovery.
Next, it’s my turn and I follow in as that couple files out, looking a little less gloomy than when they went in.
I defy anyone to describe Dr. David without using the word distinguished. In his mid-sixties, with salt-and-pepper hair, he carries himself with the regal bearing of an emperor. Tall and stately, in a crisp, immaculate, long white lab coat over dress shirt and pants, he exudes authority, confidence, and self-value.
We sit in his office, a tiny, utilitarian, windowless room, plain and unadorned; there are no ego walls covered with diplomas, certificates, and awards. There’s a desk with a computer, two chairs, and a table upon which there are three items: a plastic life-sized model of the heart, red for the oxygenated vessels and blue for the others, and two small gadgets encased in clear plastic – which I recognize as heart valves. Not one unnecessary item, not even the box of tissues most doctors keep on hand. No tears here. He only offers hope. It’s what every patient wants but not every doctor can provide.
On his computer, Dr. David calls up Dr. Morse’s summary of my medical history, Dr. Drobac’s referral letter, Dr. Sternberg’s angiogram – all smoothly integrated on our still-evolving electronic patient record. He glances at each report as it pops up on his computer screen, then turns to me and gets down to business.
“Your valve is severely constricted,” he says, pointing out the narrowing of the vessel on the image on the screen, “and your aorta is dilated. The valve has to be replaced with either a tissue or mechanical valve and the aortic with a Dacron graft.”
Hearing it spelled out like that, I suddenly realize how much work this means for him. With the need to repair my aorta, as well as to replace the valve, it will be a longer surgery and additional risks due to more “pump time” during which my heart will be stopped and I will be kept alive by the heart bypass machine. He asks about my symptoms and I don’t hold back now, telling him about my fatigue, the tightness in my chest, my breathing difficulties, and my lack of stamina.
He gets up and goes out to his secretary to see when he can fit me in.
While he’s out of the room, I sneak a peek at my chart, open to the screen of Dr. Drobac’s report to him. “Thank you for seeing this pleasant, mildly overweight 49-year-old mother of two …” it starts out. I guess it’s a better description than “interesting case,” considerably more optimistic than what one doctor wrote recently in a patient’s chart: “A puzzling story that started with a constellation of unfortunate events,” and believe me, no one wants to be described as having an oddball condition, known by the nickname of “fascinoma.” I’m just about to scroll down when Dr. David comes back in to tell me his news.
“I want to do your surgery as soon as possible. You are symptomatic and it can’t wait.”
“When?” I ask.
“You need it sooner rather than later.” He pauses. “There’s just one problem.” He rolls up the sleeve of his lab coat and then his shirt to show me his left arm. “My arm is broken.” A recent fracture was not set properly and is causing him pain and reduced mobility. He needs another surgery to have his arm realigned. “I would be pleased to refer you to a colleague.”
“But I want you,” I say, not the least bit concerned about having a one-armed surgeon. I am taken aback by his humanness. So he’s going to be a patient like me, too!
“It will have to be next week. After that I will be off for mine.”
As soon as possible, please, but does it have to be so soon?
“If I do your surgery, I will be with you every minute in the operating room, and later, I will see you in the ICU, but I won’t be there to follow your progress on the floor. My associates will take care of that.”
Am I worried that my surgeon won’t be available post-operatively? Not a bit. Anyway, when doctors say, “I’ll check on you later,” what it really means is the floor nurses will monitor you for problems or changes in your condition and do what’s necessary or pass along their observations. It’s like the phrase “we’ll keep you in for observation” is just another way of saying “nursing care,” because as old Flo’ Nightingale said, in her accurate but limited view of the purpose of the nurse: “The central role of nursing care is observation.” Yes, the post-op period is every bit as dangerous as intra-op, but by then I’ll be counting on the ICU and then the floor nurses to pick up on any problems. Then there’s always the Rapid Response Team that will come if I get into trouble. Most surgeons aren’t all that interested in the pre- or post-op phases anyway – only the more exciting intra-operative action. But then I recall another of Meera’s comments. “I’ve seen Dr. David stand at the bedside, watching urine, couting the drops coming out of a patient whose kidneys had taken a hit and was going into renal failure. He cares about every detail.”
How many of us inspire that kind of confidence in the way we do our work?
Dr. David explains another decision I must make, the type of valve I want. He’s probably given this information to hundreds of patients but goes over it with me now with not a touch of blasé. All in a day’s work for hi
m, yet he acknowledges the enormity that this is for me.
My choice is between a mechanical valve made from a metal such as titanium or a tissue valve, taken from the heart of an animal such as a pig, horse, or cow. He lets me hold and look at the samples of each. The mechanical valve may last indefinitely, but I’d have to be on blood thinners in order to prevent clots forming around the valve. It also causes a loud ticking that some people find bothersome. On the other hand, while the natural valve doesn’t require anticoagulation, it has a lifespan of only ten to fifteen years. Dr. David doesn’t indicate a preference or personal opinion but does add that by the time the tissue valve wears out, it may be possible to replace it by a minimally invasive procedure, through a catheter in my femoral artery, and not require another open-heart surgery.
He hands me documents to read. They are consent forms that give him and his team permission to perform this surgery as well as any emergency procedures that might be necessary, including blood transfusions, a pacemaker, and even resuscitation.
The thought of a blood transfusion puts me in mind of the national blood scandal in the 1980s. It was one of the worst public health disasters in Canadian history. The Canadian Red Cross was guilty of distributing blood that hadn’t been adequately screened for some infectious diseases. Many units of blood, unknowingly tainted with the hepatitis C or HIV viruses, were given to patients. Thousands of people became infected. But now I try to replace thoughts of that horrific episode with my knowledge of all the measures that have been taken and are now solidly in place to ensure that the blood supply is clean and safe.
Then there’s the other, more common problem associated with blood – the perennial shortage. A famous hospital legend has it that once, when a patient suffered massive blood loss in the operating room, Dr. David ordered everyone around the table to donate blood to replenish the blood bank. What if I need a transfusion? Will there be enough for me? There’s no time to store my own.
