I'm Not Dead... Yet! (39 page)
Times have changed—this camera and the tethering wires are much smaller than the first time I had to take this test in the early 90s. (And the surfer technician dude was eaten by a shark. Really.)
Later, I told our best friend, who happens to be gay, about the TEE test. I was re-enacting and full of wonder and energy.
“I had to swallow this big thing that was at least a foot long!”
“Yeah, so?”
“Well,” I continued, pissed that he wasn’t even slightly alarmed or sympathetic, “it was connected to this ultrasound camera and I wasn’t allowed to gag! And it was like this long!” I held out my arms as far as they could go for effect.
“Yeah, so?”
Nothing. As a matter of fact, nothing about this test seemed to faze him.
Let me clarify: many of my friends are gay. I once got into a fight because a homophobic ass on one of my sets said, “Where do all the gay Santas go for vacation? Santa
Fey.”
(Whack!) I can discuss things other than sports with these men and almost down to every gay friend, man or woman, they are caring and kind. I think it’s because of all the shit they have to put up with their entire lives, and people who have been persecuted for their sexual orientation seem to understand ardently acute personal pain—and that gives them a sense of compassion for others. At least, that’s what I’ve noticed. As a matter of fact, if I had to go to war, I’d be glad to fight side-by-side with my gay friends. And for heavens sake, let them marry if they love each other—like the rest of us. (Jumpin’ off my soap box…)
The results of my TEE had my doctor worried. They weren’t certain, but thought they saw a shadowy ‘vegetation’ on my aortic bovine valve. Vegetation means some kind of bacterial growth that can lead to many things worse than valve replacement—like heart replacement. Not good. Whatever was going on with my valve, I was on a fast track for open-heart surgery.
There was no time for ‘what ifs’—I needed open-heart surgery stat. If there had been the luxury of time, we would have gotten a second opinion from Dr. Laks at UCLA.
The ‘cardiologist to the stars’ worked out of Cedars Sinai Medical Center—not UCLA. We had never discussed it, but because Karla’s mom Vivienne had died at UCLA, I wasn’t about to put the love of my life in a place where every hallway, color, odor, would be a reminder of that tragic day. So Cedars it was. ASAP.
Our cardiologist presented what he thought was a good choice for my second valve surgery: the Ross Procedure. (Karla knew about it from scouring the internet for information about non-mechanical valve possibilities. She knew the last thing I wanted was to be on Coumadin for the rest of my life.) The cardiologist said,“the statistics show the Ross Procedure lasting twenty years or more,” and like the bovine valve, the only med I’d have to take was one aspirin a day. And this is where my gamble failed. Because of my arrogant, control-freak need to get this over with immediately, there was no time to get a second opinion; no time to discuss the pros and cons or concerns regarding the Ross Procedure. There was no time to meet with the new surgeon beforehand.
He handed Karla pages of xeroxed information about it that he had just downloaded from the internet. (That alone should have given us a hint that the Ross Procedure had not been done very often at this hospital, but we did not ask that all important question: How many successful Ross Procedures had the surgeon done here?) Karla was encouraged by the possibility of twenty years or more without me having another open-heart surgery for valve replacement. Twenty years is a lot of time for new techniques to be developed. If it lasted until 2018 maybe something new would be invented.
I see a mouth saying this phrase in super-slow motion every time I think about it. Probably 120 frames per second if we were shooting 35-mm film. And yes, just like on Sesame Street, a new phrase entered my life:
The-Ross-Procedure
.
Basically, the Ross Procedure is a technique that consists of the surgeon taking the patient’s pulmonary valve off of the pulmonary position and placing it onto the aortic valve position and then placing a cadaver valve (okay, a pulmonary homograph) on the pulmonary position.
Twenty years or not, here is where my logic chimes in: If there is
one
valve that is giving the patient problems, why on earth would we want to start cutting into
two
valves? As a director, or anyone who juggles tons of satellite issues at once, this question should come to mind: ‘Why create
variables?’
When solving problems, we want to diminish the variables, not expand upon them. I never spoke up. (I’m sure any of the producers I’ve worked with can’t even imagine that: me ‘not speaking up…’)
Unlike my first surgery, where we had spent an hour with Dr. Laks in his office, Karla and the kids, my parents, my sister Shelli, brother in law Moshe, and our best friend Cliff were all crowded in my hospital room the night before my surgery when my surgeon finally met me to speak about his plan for the next morning. I didn’t ask anyone to leave. He talked to us as if we were in high school:
THE SURGEON
“
The aortic valve does most of the heavy lifting in the heart. That’s why the bovine and porcine valves wear out in that position. Replacing the pulmonary valve with a homograph or even a porcine tissue valve isn’t such a big deal because the pulmonary position doesn’t take the same kind of pressure, and whatever we put in there will last. Research has shown placing your own living tissue valve in the aortic position—the place that gets the most wear and tear—will potentially last the longest.”
ROBBY
(Dumbfounded:)
“Uh, okay.”
The surgeon was careful to mention if the pulmonary valve-size didn’t match perfectly, he would most likely use another bovine valve on my aorta. I had been told, off-the-record, this had been the problem with Arnold Schwarzenegger who had the Ross Procedure recently at another hospital—and it failed while he was in the ICU. They had to take him back into emergency surgery, reopen him up and change the valve to save his life.
I’m not a doctor and I never played one on TV, but the question occurred to me again: why would anyone mess with
two
parts of the human heart when only
one
part is in need of help? (There are many, many good answers to this question and the people at The Cleveland Clinic answered them beautifully for us recently and even came to the defense of the procedure, which can be right for
some patients
.)
The meeting with my surgeon, the man who was going to saw me open again and put his hands on my heart, lasted less than ten minutes. (I’ve spent more time with a used car salesman.)
He was very specific and convincing. (‘And this Volvo only has 20,000 miles on it.’)
My cardiologist told me my surgeon’s father, who lived outside the country, was tragically dying, and believe it or not, my surgeon was going to stay one extra day in the States before flying to his father’s side, just to operate on me. That alone was extremely persuasive.
That sacrifice hit me hard on a human level, even though I kept thinking, ‘Why would we want to deal with the variables? It makes no sense.’ But after all: I was the guy who knew his valve ripped and directed a pilot, putting off my surgery. Was a guy with Greed and Stupidity tattooed on his forehead allowed to question a world-famous surgeon?
Because of my plan, we had to trust my doctors because ‘doctors know everything and they would never experiment on me.’ Karla and I exchanged looks and with one small smile, it was a done deal. If it fit, the Ross Procedure it would be.
So… I pretended to take a deep breath and said, “Let’s do it!”
The next morning, ‘they did it.’
Cedars Sinai Hospital knew how to take care of the families in the waiting room. A representative would update Karla as to where they were in the surgery and how I was doing and she would share it with my family and friends.
The representative came out and told her I was doing well and the surgeon had finished the hardest part—harvesting my pulmonary valve and successfully sewing it onto the aortic position. Karla recalls him saying she would not be speaking with my surgeon as he was leaving for the airport.
These words would hold great meaning six and a half years later: “Another surgeon is finishing up the easier part of your husband’s surgery...”
What makes open heart surgery so brutal?
It is a Kafkaesque experience that is really a continual enigma of
uber
horrors from surgery to surgery. Its impact varies depending on the patient’s age, spirit going into the surgery and health prior to the surgery. But,
break no chest bones about it
, the surgery begins with a 10 - 11 inch-long incision right down the middle of your chest. This, of course, after you are under general anesthesia—so you feel no pain.
I don’t want to upset anyone so I’ll keep this as simple as possible, because even as I type, I can imagine the fear in a first-time patient or loved one reading this. Even though it is a defenseless massacre that takes place upon the entire body—and the patient’s future mental condition (in a second…)—you should know what happens when the patient is in the O.R.
The next thing to be assaulted is the patient’s breast bone which is separated so that the medical team and the brilliant surgeon (hopefully) can see the heart, and in my case my aortic valve. The aorta itself is the main thoroughfare that sends blood from your heart and then to the freeways that make up the transportation in the rest of the patient’s body.
The apposite next step is the life-saving, yet life-changing connection to the heart-lung machine. It is basically a mechanical heart in the sense that the patient’s heart is stopped, but the rest of the body still needs to receive appropriate and very necessary oxygen-rich blood.
Why do I believe it is life-changing? There have been studies regarding what the heart-lung machine does to a patient’s mental abilities once the patient is out of surgery. Its afterlife effects have been noticeably affected by
moi
. See? I’m not as funny and it’s the only French word I remember after eight years of French in school.
I’ve been told, I forget by whom, that the heart-lung machine can affect memory. I can’t remember if that’s true. I’ve also been told that the heart-lung machine can induce a sense of fogginess and this is exponential with each passing, let’s say, hour a patient is on the machine. I can’t tell you who told me this because I’m a bit foggy so I don’t know if it’s true.
Where was I? (This memory abuse is so true that in my teaching career, I ask the student in my classes who I believe to be the most alert to always help me stay on track when I go off on a tangent and then completely forget where or why I even went on that tangent.)
I’ll also admit, even though it’s early in the book, that I have had four open-heart surgeries so my fogginess is like that of the Blue Ridge Mountains (sometimes I have brain games to keep my mind alert—like I learn new musical computer software and always keep my brain exercising, the same way I keep exercising my body. I refuse to give up or give in), and a one time open-heart patient’s fogginess could be like the need to wipe down their computer screen every few months.
