My Telltale Heart

The aorta is shaped like a walking cane. The "handle" end rises out of the heart 3 to 4 inches to the top of the chest, where the carotid arteries branch off to the brain. When the inner layer, or intima, of the aorta dissects, it separates from the artery's other two layers, and often tears. A violent dissection can literally rip the carotids off where they attach to the aorta, causing instant death. A milder dissection creates a "false" channel, or pocket, into which the blood flows. This is what Sumner and Newman saw in those "beautiful" pictures.

My dissection misdirected some blood into a false channel, but left an opening for the normal channel for circulation to the rest of my body. Sometimes, however, the false channel takes all the blood that the heart can pump, quickly creating a dangerous dead-end. Under continuing pressure from the beating heart, the aorta can rupture, flooding the pericardium, the protective sac that surrounds both the heart and the aorta. The heart cannot beat in a pericardium suddenly filled with blood -- again, instant death.

In my case, some natural defense mechanism in my body was activated at this moment of crisis that gave me further protection. Normal blood pressure, measured in two numbers, is 120 over 80. My own blood pressure was typically a little higher, about 140/85. But on the morning of March 26, when a nurse took my blood pressure at 11 a.m., it was 77/54. My pulse, usually 65 to 75 beats per minute, was 56. For the next five hours, these low readings hardly changed.

This, literally, was just what the doctor ordered. Medical texts instruct emergency doctors to treat an aortic dissection with medications to lower the blood pressure and pulse rate, to reduce pressure on the aorta wall and avoid more damaging tears. But my body didn't wait for medication. It did this on its own.

"It was kind of like God was smiling that day and wanted you to make it," Sumner said later -- not exactly a scientific explanation. He also offered another theory: Though I had some bad genes that contributed to the dissection, I also had some good ones, which gave me excellent cardiovascular health outside the aorta, and I was generally in good shape, making it easier for my body to protect itself.

When Sumner reached his final diagnosis at 3:04 p.m., my survival was by no means assured. I needed surgery immediately. Sumner called the heart surgery group at the Washington Hospital Center, his first choice in a cardiac emergency. When Paul Corso, the chief cardiac surgeon there, heard Sumner's account, he said he would send a helicopter to pick me up, and would operate as soon as I arrived.

Now Sumner returned to the emergency room, where my wife was waiting, to give her the bad news. At the same time, our friend Janice Downie, who lives near Sibley, arrived in the emergency room to be with Hannah. Sumner took them both downstairs to tell me about my situation. Hannah and Janice both remember the conversation as deeply shocking. I don't remember it at all. Sumner had given me a calming drug, Ativan, and a painkiller, Toradol. I was mellow. I remember very little that happened after I took them.

Sumner began by saying this was perhaps the worst day of my life. He told Hannah that "your husband could die at any moment." But he also said there were better possibilities: Aortic dissections can be surgically fixed, and I would be going to an excellent surgeon, fast, by helicopter. I have a vague memory of anticipating my first helicopter ride since the Vietnam War. And then nothing happened. The helicopter did not arrive. I lay there. Hannah and Janice nervously checked every few minutes with a nurse -- where's the helicopter? After about 45 minutes someone told them the wet, blustery weather made it impossible to fly. So the hospital center had sent an ambulance. We had no choice but to wait for it. Sibley has no ambulance of its own, and Sumner said there was no point in calling a D.C. ambulance, since they usually refuse to transport patients from one hospital to another, on the grounds that they are already in a hospital.

The Washington Hospital Center ambulance finally arrived at 4:22 p.m. Two young men bundled me into the back of the truck. Hannah rode in front; a technician who was monitoring my vital signs rode with me. Rush hour was just beginning as we set off on the nine-mile trip. On Military Road the traffic was suddenly heavy. Shouldn't you use the siren, Hannah asked the driver. It's up to the man in back, the driver responded. The technician had already made clear his concern about a bumpy ride -- I needed to be kept as still as possible. But now he agreed to use the siren, and the driver pointed his ambulance into the oncoming lane. He never drove fast, but with the siren blaring and lights flashing he could drive steadily, without stopping.

When we arrived at 4:50, Dr. Corso was waiting. Hannah was struck by the relaxed atmosphere in the emergency room. It felt a little like a cocktail party, she remembered later. Corso seemed more like a cordial host than a surgeon who was about to save her husband.

Months afterward I asked Corso about this. The apparent calm was deliberate, he said: "No one wants to see a surgeon coming out there who looks in a panic." In fact, intense preparations had begun. The operating room was being prepared. Blood was taken and tested.

Paul Corso is 59, tall, slim and erect. What hair he has left is mostly white. He compensates, as he puts it, with a handsome, thick mustache, which matches two bushy eyebrows. He studied medicine at George Washington University and surgery at GW Hospital. But he almost studied airplanes and flying, he later told me, which seems eerily appropriate for a cardiothoracic surgeon. The CT surgeons are known to their colleagues as the top guns of the surgical profession. They routinely take on life-and-death procedures as though they were, well, fun.

Presenting his plans for me to Hannah, Corso was crisp and confident. He didn't talk about the possibility that I could die at any moment, nor did he reveal any anxiety about what he was about to do -- he had done similar operations more than 200 times. I heard his explanation, too -- I've seen my signature on a permission form authorizing him to cut me open. But I have no memory at all of signing the piece of paper.

I was on the operating table at 6:30. When he saw the computed tomography (another CT) scan, which had come in the ambulance with me, Corso said later, he saw grounds for hope that my dissection was limited in size and seriousness in ways that would allow a relatively simple repair. At the same time, he had an entire artificial aorta -- an "elephant trunk," the CT surgeons call it -- ready in case the damage to mine was greater than he expected. "You never know how complex it's going to be until you get in there," he said later.

I WAS PUT TO SLEEP and laid out on an operating table that tilts in all directions. For this operation, Corso puts the patient on his back, and tips the head down and the feet up. This posture reduces the chances of air bubbles in the bloodstream rising into the brain.

Corso began at 6:35 p.m. by sticking things into my body: a breathing tube down my throat to force air into my lungs; a catheter tube through a big vein in my neck and into my heart to monitor pressure, blood flow and temperature; another finger-size tube down the throat into my stomach to take continuous echocardiograms that would allow the operating team to "see" everything in the center of my body, from my esophagus to my stomach.

Using those devices, Corso then made an inside-out inspection of the damage. No visible surprises. Nurses then prepped me with a Betadine solution from my ankles to my chin, shaved a lot of body hair and got me into position. Corso began.