My Telltale Heart
Only later did I realize that by devoting my daydreaming time almost compulsively to writing projects, I was, I think, asserting my determination to resume my professional life. I may have had a close call, but I did indeed dodge the Reaper.
I RETURNED HOME ON APRIL 6, the day before my 60th birthday -- the beginning of the rest of my life, a cliche that suddenly had new meaning. Virtually everything suddenly had new meaning, beginning with "family" and "friends." These two had come through for me in the most profound way during those 11 days in the hospital. Once I had really regained consciousness, Hannah read scores of e-mail messages from friends and colleagues, and they had the effect of a fine tonic on my spirits. I could sit for 45 minutes listening to her read cheerful, affectionate messages, and feel physically better when she finished. Don't ever wonder if you should write to a friend in the hospital; just do it.
Being home without the hospital center nurses was hard, particularly on Hannah, who had to feed me, wash me, give me my many pills, help me dress and much more. After open-heart surgery the lungs are almost invariably bruised. The body has been cut up like a salami; many wounds have to heal. The beta-blocker drugs -- which slow pulse and lower blood pressure to spare the healing aorta -- left me dizzy, short of breath or just exhausted.
Nine days after I got home I took a shower. Hannah stood right beside the tub to be sure I didn't fall. Suddenly she saw the left side of my face lose all its shape and movement. I realized my left arm had lost most of its strength, and speaking was difficult. I was having a mild stroke. I was in the same bathroom I'd been in when I sensed the first symptoms of my dissecting aorta just 20 days before -- here we went again.
This time Hannah called Ramin Oskoui, the cardiologist to whom Corso had entrusted my care as I was leaving the hospital. Oskoui, 39, a former varsity soccer player at Georgetown, told Hannah to take me back to Sibley, and, to our pleasant surprise, he was there to meet us. Again we remained calm on the drive out Massachusetts Avenue.
Strokes after surgery like mine are not rare. As several doctors later explained, stitches and patches in the aorta leave rough spots. Blood platelets can form small clots around these spots, and they can break loose and move up the carotid arteries into the brain, causing a blockage that constitutes a stroke. This is probably what happened that morning.
So I had another five days in the hospital. The neurologists quickly concluded that the stroke was very minor, and that its effects would be mostly short-lived. The weakness in the left arm disappeared almost immediately. Ten months later I have only a slight numbness around the left corner of my mouth and at the root of my tongue to remind me of the stroke.
Dr. Corso typically invites his patients to see him for a final conversation shortly after surgery. My meeting was postponed by my stroke, but I went to see him on April 22. This was a big moment for me, I think because I was anxious for reassurance that I really would recover from the two roundhouse punches I had absorbed.
"You had a serious problem," he said, using words I have repeated to friends many times since. "We fixed it."
He told me something else just as important: When I came into his operating room on March 26, neither Corso nor I knew that there was a history of aortic disease in my mother's family. My uncle Sam Greeley, my mother's youngest brother, had an aneurysm in his aorta in 1982, when he also received a Dacron patch from a surgeon in Milwaukee. (He's now 77 and doing well.) I only learned this history when Sam was visiting his sister, my mother, shortly after my operation. He recounted this story, then explained that his mother, the sister of my maternal grandmother (my grandfather married two sisters sequentially, a story for another occasion), had died, at 82, of a ruptured aorta.
Three cases in one family persuade the experts that I had inherited a congenital defect in the connective tissue of my aorta. Researchers at Cornell University have now taken on my entire family as part of a study to try to figure out the genetics of "family aortic aneurysm disease."
If mine was a genetic defect, Corso said, "then what happened to you on March 26 could have happened on any day since your 40th birthday."
Any day in the last 20 years?
This was harrowing, but ultimately helpful, news. My passport would show that in those years I had traveled throughout Western Europe, in Russia and across Siberia, to China, Indonesian Borneo, Uzbekistan, Kazakhstan, Tajikistan, Slovakia, Romania, Bulgaria, Chile, Brazil, Argentina and several other exotic places. Few if any of those countries have the doctors or facilities to deal with an aortic dissection; if struck in any of them, I probably would not have returned.
This conversation profoundly altered my sense of what had happened to me. Initially I felt that my aortic dissection had ended my charmed life -- my luck had run out. Corso's words upended that conclusion. If the dissection was caused by an inherited genetic flaw over which I had no control, and if the dissection occurred when I was perfectly positioned to get speedy, successful treatment and a repair that could last for 20 or 30 years (which Corso also predicted), where was the bad luck? No, I had to conclude, this was another example of my charmed life.
Everything about my aortic dissection, down to the excellent prognosis the doctors now give me after the final healing of my carotid artery and the total success of all the other repairs, was an example of good luck. It starts with the insurance card in your wallet. If you have to suffer an aortic dissection, try to do it with good health insurance -- it's expensive (more than $120,000 in my case). And luck should bring you to the emergency room in the late morning, when the chief of emergency medicine is free to take on your case himself. He should be a creative practitioner who is familiar with aortic dissection -- one of the most misdiagnosed medical crises in the lexicon. Everyone should be so lucky.
DAUGHTER CHARLOTTE'S WEDDING to Nick Peterson on May 10 was wonderfully timed. Of course it was unfair to Charlotte and Nick to have the ghost of the dad who almost wasn't there hovering over the event like a cloud. But they were forgiving, and for the dad who was there, who could give a toast and embrace the guests, it was a glorious spring day, literally and figuratively.
The May sun was warm and spirits were high. For me it was a day of great promise. I could dream of grandchildren and a second daughter's wedding someday -- even of a big-league baseball team in my home town. I could dream of a future that had almost eluded me entirely. And there have been many more glorious days since, days that are memorable not because of any fame or fortune, but just because they happen.
When friends now ask what lessons I learned from this adventure, my first answers are hardy perennials: Seize the day, appreciate the ordinary. Wisdom or just cliche, the label does not alter the satisfaction I can now take from a wife's smile, a daughter's tease, a friend's hug, the angular light of a bright winter sun in an infinite blue sky.
An acute Type A dissection of the ascending aorta has killed many. It nearly killed me -- but it didn't. How sweet it is to type those words.
Robert G. Kaiser, an associate editor of The Post, is a native Washingtonian who, during a 40-year career at the paper, has covered the Vietnam War and the Cold War in the Soviet Union, and has served as managing editor. He will be fielding questions and comments about this article Monday at noon on www.washingtonpost.com/liveonline.
© 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)
_____Interactive Graphic_____ • My Telltale Heart: A look inside Robert Kaiser's life-threatening heart condition and the surgical procedure that saved his life.
_____Live Discussion_____ • Kaiser and surgeon Paul Corso discussed the surgical procedure. Read the transcript.