HEARTSOUNDS is a disturbing book. In it Martha Lear, a writer and former editor at The New Times, tells what happened to her husband, Dr. Harold Lear, from the time of his heart attack on August 10, 1973, until he died of heart disease on September 13, 1978. It is an engrossing, touching and very frightening book.
Dr. Lear was a urologist. He had a successful practice in West Hartford, Connecticut, but, at the age of 49, he decided to make a career shift, to "quit one-to-one medicine. Do something more . . . socially useful. Community medicine, maybe. Planning health care programs for communities. Research. Teaching. A teaching hospital, maybe Boston, maybe New York . . ." Martha Lear, his second wife, 11 years younger than he, was delighted. She wanted to get back to New York.
After making inquiries Dr. Lear decided to become a specialist in human sexuality, at that time a relatively new field of medical interest. He spent one year studying in Philadelphia and then moved to New York to start a program at the hospital where he had trained 25 years earlier.
The first few months were frustrating -- he had his office in a small, renovated kitchen and had to share it with two technicians, one of whom always brought a dog to work -- but after several months and despite little support from the hospital's director, he developed a very successful program. Then, the psychiatry department head, who had previously ignored all his invitations to participate in the program, decided that sex therapy was the province of the psychiatrist, not that of a renovated urologist. Lear was squeezed out. (Anyone who is under the Illusion that academic medicine is above the mean-spirited competitiveness that sometimes blemishes private practice will learn here how wrong they are.)
Lear had a massive-heart attack. (martha Lear suggests, and it may be so, that frustration in his work caused excessive stress which precipitated the heart attack.) Home alone at the time, he managed to stumble out of his apartment, down to the foyer where he asked the doorman to get a wheelchair and take him immediately to the hospital, a few blocks away. He expected that once there, under medical care, the worst would be over. As it turns out, his hospitalization was the beginning of a five-year nightmare.
Lear's doctor was out of the country, and a Dr. Roberts took over his care, Roberts was a disaster -- cold, callous, arrogant, the kind of doctor no one could like. Martha Lear, understandably, wanted to know all she could about her husband's heart disease, but neither she nor her husband -- whom she call Hal -- were able to communicate with Dr. Roberts. When Hal finally recovered, partially and temporarily, from his heart attack, they switched to his own doctor.
Hal, sadly, never recovered to the point where he could return to work. His heart muscle was extensively damaged by his heart attack, and it could barely pump efficiently enough to keep him out of heart failure while he was at rest. X-ray showed an aneurysm -- a ballooned-out area -- in his heart, and that two blood vessels to his heart were partially blocked, a third completely blocked. Hoping to improve enough to live a comfortable, if limited, life, he underwent open heart surgery for removal of the aneurysm and construction of by-pass grafts to the partially blocked vessels. Unfortunately he suffered another heart attack during the operation and postoperatively his blood pressure remained dangerously low for days. When he returned home he found his memory for recent events badly damaged. He could not remember things from one moment to the next; he also could not make change, nor find a restaurant to which he had been many times, nor spell simple words. He had become prematurely senile, a result of brain damage which was caused by prolonged low blood pressure, but, unlike the elderly senile person, he was fully aware of senility, which made the condition particularly unbearable.
Next began a dismal, frustrating odyssey -- a search not for good health, which he realized he would never have, but simply for the strength to live a bearable life. He was plagued by recurring episodes of heart failure, by high fevers for which no cause could be found, and always and most devastatingly, by his impaired ability to think and remember. There were times when he felt well, when he believed he had finally conquered his illiness, and he became elated at such moments. But they always ended, usually in a very few days, disastrously. Martha, whom Hal calls "Mushie," soon realized just how false these hopes were. Here is an exchange between them:
"'You're feeling all right?' I asked cautiously.
"'not all right, Fantastic. I fell fantastic, Mushie, I think we've turned a corner'
"Sick was okay and okay was good and good was fantastic. We were always turning corners. These were the siren songs he sang, and for a time I was beguiled. 'I'm well, Mushie, I'm over the sickness.' 'You promise?" 'I promise.' Ah Hal, sing another song of safety. You're a doctor, you surely know the tune. But as we kept turning corners and winding up in dangerous places, I stopped trusting. Tin-eared bastard, you'll wreck us both. There are rocks out there." Martha Lear is an eloquent, powerful writer.
With these few transient exceptions, brief episodes when he had hope, Hal's life, from his first heart attack till his death five years later, was an unadulterated hell. And so was that of Martha who loved him very much and was forced to stand by and watch him suffer.
All of this is sad, of course, but what disturbs and frightens the reader is that much of the anguish which Hal and Martha suffered was caused not by his heart disease but by the doctors who were supposed to be treating him. His private doctors only half listened to his complaints, belittling early signs and symptoms till the diagnosis was so obvious that an orderly could have made it. The interns and residents in the hospital labeled him a complainer and ignored his requests for medicine and consultation until he was so critically ill that it took desperate measures to save his life. Both he and his wife were often misled, mistreated and ignored. And, since he was a physician, we would expect that he would have received the best possible care. If this is the best of care, God help those of us who must accept second best.
I wish I could say that Martha Lear has painted a distorted portrait of medical care in the United States, but I can't. (There are a few factual errors in the book. For instance, the mortality rate for coronary angiography is closer is .5 percent than to 5 percent, though it might have been 5 percent in the hospital where Lear had his operation.) I recognize in her book many of the doctors I know. Sadly, I even recognize myself.
I think most physicians, if they are honest, will admit that at times they have ignored patients' symptoms and written them off as hypochondriacs, until organic disease is far advanced; have dodged apprehensive family members because they didn't want to spend time explaining complicated medical problems; have been less than honest with patients when discussing complications that have been caused by physician ignorance or neglect, their own or another's. We shouldn't ever be guilty of these sins, but occasionally we are.
HEARTSOUNDS is not only a well-written, gripping story of one man's futile fight for life, it is also a book with a message: patients of the world speak up, you have nothing to lose by complaining, I am inclined to agree.
The A.M.A. HEARTBOOK is a compilation of all that is known about heart and blood vessel disease. Each chapter (e.g. "Hazards of Smoking," "Cardiac Emergencies," "Coronary Artery Disease") is written by a physician who has a particular interest in that field. The illustrations are clear and easily understandable, as is the text of most chapters. There is probably more about cardiovascular disease here than most people will care to know, but for the lay person with $25 to spare and a burning interest in the subject this book is the best I have yet seen. I don't expect it to be surpassed soon.