My Telltale Heart
Next Corso measured the bruised area of the "proximal" aorta, the section closest to the heart where the most serious dissection had occurred. He decided to replace a three-inch section with a size 28 Dacron graft, a grooved tube 28 millimeters, or about 1.1 inches, in diameter, made of knitted Dacron velour. This material is used because the body seems to like it; blood platelets quickly line the inner layer, making it look and behave like a human blood vessel, while other cells surround it on the outside. In just a few weeks, the Dacron graft is covered, inside and out, with the patient's cells. Corso stitched one end of the graft to the upper part of the ascending aorta.
Next he had to decide whether the dissection had so damaged the aortic valve that it would have to be replaced. The aortic valve consists of three leaf-like cusps that open with each heartbeat to allow blood to pass from the left ventricle, the heart's main pumping station, into the aorta. Normally, the inner wall of the aorta holds the valve in the proper alignment, but the dissection had allowed it to droop, so it leaked. Corso thought he could "re-suspend" the valve with a few well-placed stitches that would restore it to proper alignment. After putting in those stitches he poured a little water on the valve to make sure it had stopped leaking. It had.
All that remained was to stitch the base of the graft to the remaining bit of original aorta, just above the valve. Now I had a reconstituted aorta, ready for use. Slowly, Corso and his assistants brought me off the heart-lung machine. They warmed my blood back to 98.6 degrees. My heart started to beat again on its own, prompted into action by the warm blood's effect on the heart's own internal pacemaker.
"I had your heart in my hand," Corso recounted. "I could feel how well it was squeezing."
The operation had taken 4 hours 42 minutes. At 11:20 p.m. Corso could go out to the waiting room to tell Hannah and our daughter Emily, 28, that the operation was a success. Almost giddy, they were soon on their cell phones reporting the good news to daughter Charlotte, 30, and other family and friends.
I WAS "A BAD PATIENT," as Dr. Corso put it when we had our first real conversation about the operation several weeks after I left the hospital. In the days after the operation I was obstreperous, and kept trying to pull the tubes out of my body. "We couldn't orient you," he said. Usually, he explained, a patient knows in advance what the effects of his open-heart surgery are likely to be, so he isn't surprised by what occurs. They didn't have a chance to brief me, he said.
For nearly a week after the operation I was out of it: sedated, bloated, uncomfortable, dependent on oxygen pumped into me through a mask. My wife and daughters found me a rather pathetic and often terrifying sight, sometimes shaking like an aspen leaf, unable to speak, kept alive by numerous tubes coming into and out of my body. My ankles were so swollen they disappeared. I rarely opened my eyes or moved for several days. My complexion was yellow. The doctors and nurses kept telling Hannah everything was fine.
And slowly I got better. On March 29, three days after the operation, Hannah reported that when Emily told me it was 5 o'clock in the afternoon, I announced that "the sun has passed over the yardarm." (It would be months before I made good on that old saying and had my first cocktail, however.) On the same day, I allegedly told an attractive blond nurse that she was "a sight for sore eyes." I remember none of this. During the first week I was actually tied down in bed.
My first memory, I think, is of a nurse telling me in a loud voice: "Mr. Kaiser, you cannot do that. You CANNOT do that! You have had serious open-heart surgery, and you simply cannot do that!"
I don't remember what "that" was, and I don't remember a face, just the voice. But I do remember thinking I was in some kind of dream. I knew something had happened to me; I must have understood that I was in a hospital. But open-heart surgery? That made no sense. My healthy 90-year-old parents had no heart trouble, nor did any of my relatives. So how could I have needed heart surgery? Obviously I was dreaming.
Doctors came often, and they must have kept telling me what had happened. I remember being told several times that I was "a very lucky man." Slowly, all this talk began to sink in. Hannah remembers standing beside my bed in the ICU on March 30. I took her hand in mine and said, "Dr. Sumner saved my life."
As the sedation was reduced, I began again to pay attention to my surroundings. I wanted to read the paper, but I was still too weak to muster the energy and focus, so my wife and daughters read aloud to me, a great pleasure. Hannah brought a boombox to my room, so I could listen to Mozart, and to NPR. According to Hannah, I interviewed every nurse and technician who came into my room about my situation. The war in Iraq was beginning -- I was missing a big story. I resolved not to be bothered. The war was big news, but in my life, it would not make the front page.
As I got better I had to absorb the thought that I had "dodged the Reaper," in the wonderful phrase of John Bigelow, a friend since high school and author of one of the many cheering e-mails I received during those days. This was hard; at first I thought a near-miss like this could create real psychological problems.
I had nearly died because of an ailment I didn't know I had -- indeed, probably could not have known I had. Corso said later that if he had used the magnetic resonance imaging (MRI) machine, the best "eyes" modern medicine has to see inside the body, to look at my aorta just 10 minutes before my dissection occurred, "it probably would have shown nothing."
At first the mind reacts to trauma reflexively. My reflex was to think about future writing projects. While still in a drugged state, sleep-deprived by the ICU routine that involves constant waking, noise and disruption, I asked Hannah to let me use her laptop computer to make a few curt notes.
The first one said: "You just saved my life, and what am I going to do about it? Write a newspaper article? Isn't that slightly ridiculous?"
This was a reference to the article you are reading. I decided in those first days in the hospital that I would try to write about how Drs. Sumner and Corso saved me. I also wanted to say, in print, what attentive care I received from everyone at Sibley and the Washington Hospital Center. Then, as now, this seemed like a small, perhaps feeble gesture, but writing is what I do.
© 2004 The Washington Post Company
Paul Corso, chief cardiac surgeon at Washington Hospital Center, holds a graft like the one he used to repair the author's aorta.
(Sara Hirakawa - For The Washington Post)