In this creative essay, James Borton explores the lived experience of heart bypass surgery and recovery.
Here bring your wounded hearts, here fill your anguish; Earth has no sorrow that heaven cannot heal.
Thomas Moore, Come, Ye Disconsolate, 1816
‘JB, JB does your boo boo still hurt?’
‘No, Eli, my heart is healing.’
All this four-year-old needs is reassurance that his grandfather is going to be all right. It’s now bedtime and he wants his favorite story, Barthello’s Wing: The Tale of a Very Brave Bug, read to him.
All right, maybe I need the story more than he does but it is our game and I am blessed that he wants to play along with this reading ritual when I show up for my regular family visit with him and his parents in Aiken, South Carolina. And so, as his beautiful little head with its silky straight dark hair hits the soft pillow and he clutches his treasured and well-worn teddy bear, Patches, I start our story.
The heart. What do any of us truly know about matters of the heart? The world is full of people who have damaged hearts and only a few are lucky enough to receive a proper diagnosis or prescription for right living and loving.
For sure, science informs us that the most powerful muscle in the human body contracts some 100,000 times a day and pumps nearly 2,500 gallons of blood in one day throughout the blood vessels by repeated, rhythmic contractions.
Every 34 seconds someone in the United States dies from heart disease. An estimated 170,000 Americans undergo bypass surgery annually. At age 60, I became one more statistic.
The human heart possesses a uniquely marvelous rhythm in which a single flaw can spell the end of an individual’s life or offer an unexpected lesson about love. For recovering heart patients, story remains a reconstruction of a life: it’s ultimately about how we see ourselves in the past, present and future. And for most of us, storytelling is the necessary balm for the start of the healing process.
A detour to purgatory
While in a coma for nine days post surgery, it is clear that I took a sharp detour to purgatory. I am very fortunate that former teachers – two nuns from St Joseph’s School – coached me back from my deep descent into the underworld; fueled no doubt by an intravenous cocktail of drugs for pain and deep sleep. Even so, I can recall all too much of my brief brush with the afterlife and the associated vivid shadowy images.
My triple bypass surgery resulted in an ’empty heart’. Despite all the assurances that I was an exceptional 60-year-old candidate for this type of surgery – reinforced by the Heart Hospital’s professional nursing staff’s mini-placard placed prominently in sight of my stainless steel sterile hospital bed: EXCELLENT CANDIDATE FOR SURGERY – something bad happened.
The emblazoned heart on the hospital’s exterior greets visitors and patients. I was wheeled on a gurney into the bowels of the hospital’s operating room. I learned much later that an overhead five-foot diameter light shines on the surgeon and his supporting cast to ensure that there are no mistakes in the routinely repetitive procedure for making a clean incision into the front of the chest, where the breast bone is sawed neatly through by a pneumatic bone saw that resembles a band saw, and then the ribs held open by a device (a retractor) that works like a well-used carpenter’s vise.
It was in this brightly lit operating theater that the chief surgeon harvested the vein from my leg to create the bypass or detour around the plaque-filled heart arteries. Oh yes, the heart is stopped. A heart lung machine or pump keeps me alive. Upon completion of the surgery, electric paddles are routinely used to restart a heartbeat. Think of jumpstarting your car with cables after the battery has run down.
After my nearly five-and-a-half-hour hour surgery, I was one of those rare cases where it was necessary to rush me back into the operating room, re-open the already stapled and wired chest to repair a ruptured artery.
My heart begins to race upon reading the clinical history of my heart surgery and subsequent bleed out.
‘Don’t sleep, you make not wake up ever again’
After my heart stopped, it was encased in a heartnet; this cloth positions the heart for the creation of the bypasses. There’s something comforting about this notion of the heart swaddled in a net. Yet, there’s also something violent – no, terribly disturbing – about this process. Even months after the surgery, when I wanted to fall asleep, a familiar inner voice would come back: ‘Don’t sleep, you may not wake up ever again.’
Because of the extent of my re-exploration, respiratory failure and profuse loss of blood, I remained in guarded condition and was placed on a mechanical ventilator. Medical science has provided surgeons with a plethora of state-of-the-art tools to assist and provide emergency support for heart operations: heart-lung bypass machine, ventilator, infusion pump, intra-aortic balloon pump and the standby, crash start (super-charged electric paddles).
After my recovery and months later, I was permitted to inspect the more than 100 assorted medical instruments used during an open-heart surgery. The saw itself is well worn and the handle burnished from the skilled hands of the five surgeons who grip it during the more than 600 annual heart surgeries completed at the Heart Hospital.
For that matter, a reconditioned Stryker Ortho-power Sag Saw can be purchased on eBay for $349. That’s a bargain considering the average cost for bypass surgery exceeds $44,280 for a single bypass and if there are multiple bypasses it exceeds $120,000.
But perhaps the essential issue that’s hidden from many heart patients are disturbing studies that suggest it is likely that they will need another procedure to bypass the original bypass.
Cardiologists recognize that grafted vessels will have closed within 10 years in 40 percent of heart patients while other arteries will have closed in the remaining 60 percent. This means that the odds of me going back to surgery are very real.
I have not asked the surgeon if he’s a sailor, but the stab incision was closed with two stitches, a perfect figure-of-eight. After all, it’s the most common stopper knot used on halyards (the ropes used for lowering the sail) to prevent them from disappearing inside the mast by accident.
Sifting through the shards of a broken life
My daughter appeared as a sentinel at the hospital during my nine days in a coma following the surgery. Friends and family members arrived, all gathered around for a bedside vigil examining the phalanx of tubes and IVs jutting out of my body: a respirator (breathing for me), monitors, alarms, pneumonic devices, intravenous lines in my arms, drainage chest tubes, PIC lines (a type of IV) in my arms, a cardiac monitor on my chest, oxygen in my nose and a Foley catheter in my bladder.
Because of my deep coma, it’s no wonder that the conversations were at best funereal in the hospital’s intensive care unit. ‘Now does James want to be buried in a Catholic cemetery?’ ‘Or did he not say he wants to be cremated?’ ‘Who has a copy of his living will?’
Travis, my son, wrote this e-note to other friends and family members unable to travel to the hospital:
They are still planning on trying to get (dad) off the ventilator and the pump today, although they seemed more optimistic about the ventilator. The pump, if I understand it correctly, actually represents a more significant danger (associated with the diminished neurological functions). What I haven’t really been able to establish is if the time ‘on the pump’ is directly correlated to risk. There’s lots of data on bypass surgery – it is probably the most studied procedure in this country – but the issues with the pump and resulting brain damage are allegedly something less discussed with patients and their relatives.
I couldn’t really sleep last night or the night before. Here’s what I know: family – old new, extended and otherwise, is pretty damn remarkable. Dysfunctional as hell – but that just makes me feel more at home. I’ve done the bedside vigil before, and while I didn’t get kicked out of the hospital – I sure made a run at it. I keep thinking that maybe my voice or presence could make a difference, but then the more practical side of me says that I should hold off and arrive when dad and I can really spend time together – and I can make him laugh by making fun of the pantyhose that I bet they’re making him wear for circulation.
Heart surgery offers a sea change in the way the world is viewed and in relationships. I am discovering that listening to other heart stories fosters self-reflection, increases empathy and fundamentally teaches us to listen in a new way.
There are seemingly far too many ‘Code Blue’ highways in a man’s life. Acceptance opens up the heart in so many ways without the doctor’s scalpel. At the start of my recovery and release from the hospital, I desperately wanted to hear others tell me about how their damaged hearts were fixed and so I began this project of listening carefully to other heart patients and sifting through the shards of my own broken life.
Many of us write to let others or the world at large know that we exist. Or maybe it’s to reaffirm some newly identified moral compass. The heart narrative can and does help lift one’s spirits, but it can also bring to the surface the inner chaotic emotions buried so deeply inside of us that the only recourse is grief for the old self. When I stand in front of the mirror and examine the scar on my chest, it’s a daily reminder of my mortality but also a change of heart.
This is not a cautionary tale about change in the flow of blood in a blocked heart. Make no mistake, heart patients need to be screened for depression and when it comes, it’s like a tsunami wave that tumbles you into an ocean of utter darkness.
‘Lord be with me now!’
While in my coma, it is clear that I took a wrong turn and ended up in purgatory. Without Virgil as a guide, I was forced to find my way in the ashy colored underworld where I encountered two nuns from my distant past, Sister Ruth and Sister Cecilia. Both of them still wore their black habits and they were visibly tormented. They offered religious instruction to me just as if I had never left St. Joseph’s parochial school.
The two nuns, who desperately attempted to gain my attention over five decades ago, appeared with their grim faces and minus their trademark wooden rulers. Sister Ruth’s voice was the same as it was when I was 12 and a not so pious altar boy. Then I was scribbling on the classroom blackboard at her instruction, 500 times: I will obey the Holy Father and not use God’s name in vain.
Of course, I thought possibly I had indeed crossed the River Styx since it was so very cloudy and grey as if a curtain of gauze separated me from them. I desperately wanted to read their messages written on the chalkboard. Since I always lived in chronic fear of Sister Ruth’s higher authority and propensity to liberally administer corporal punishment with her heavy dark wooden ruler, I was not about to deny her. What shocked me was that the two nuns flitted about with the strangest black wings jutting out of the back of their dark habits; there was absolutely nothing ‘Sally Field’ about their harpy-like flight across my path. I continue to have night sweats and fears about what I saw in the underworld.
In that darkness I can recall one prayer or steady incantation: ‘Lord be with me now!’ Perhaps, I was plaintively revealing my baleful spiritual condition and hoping that God simply heard my cry for help. From my powerless perspective, it was the moment to enter into sacred time and forget about chasing ghosts. And so the lessons became clearer: sail into a new life with God’s grace and blessings, weave prayer into work and play; experience goodness, truth and beauty.
Only two months before my heart problem was clinically diagnosed at the VA Hospital, I received this e-mail:
Dearest,
You are losing me. I said a few weeks ago that I wasn’t going to talk about ‘it’ anymore and haven’t, but that doesn’t mean that I am not still reeling from you choosing to live away from me. Every action you have taken solidifies and grows your life in Hilton Head-one that is for the most part without me.
Yesterday I took off the ring you gave me. I don’t feel committed to a relationship that makes me feel lonely and sad. What do I want you to do? Other than to come back home, nothing. You just need to know that I am drifting away and eventually I just won’t be there.
And so eventually she was not there. Me. I ended up in intensive care on a ventilator at the Heart Hospital.
About the author
James Borton is a recovered heart patient, and sailor.
