My dad's cardio-vascular disease history began to manifest itself about three and a half years ago. One afternoon in late October, 1998 dad experienced some shortness of breath. Not very concerned, as my father rarely was when it came to his own health he called his primary care doctor to schedule an appointment for "sometime next week". Hearing his symptoms the doctor suggested that he go over immediately to be checked.
Once the doctor ran an EKG it was clear that my father needed immediate medical attention. Dad was in trouble and showing signs of an impending heart attack. After an emergency catherization they rushed my dad via ambulance from Clara Mass Hospital in Belleville, NJ to the then known Columbia-Presbyterian Hospital in NYC and scheduled him for immediate open-heart surgery.
Three of the four arteries that he had were blocked 90 to 95% and his heart was suffering severely from the lack of blood flow and oxygen. Having been a builder/contractor for the majority of his life and a very robust and active man it was a miracle that my dad suffered no permanent heart damage. Never did he suffer a heart attack or even any chest pain for that matter - simply shortness of breath. My father was 66 at the time. On November 2, 1998 a triple bypass was performed by the well-known cardiac team of Eric Rose and Niloo Edwards at Columbia. We were told that the operation was a success but that dad had a mitral valve that was leaking that may cause some future concern. At the time the doctors didn't feel it warranted any surgical attention. Later that evening they had to reopen my father as his internal bleeding was not stopping at the rate they had hoped. They re-sedated and reopened my father's chest cavity and cleaned out the area on November 3rd. Dad celebrated his 67th birthday in ICU. After a 10 day stay at the hospital dad was released.
About six months later my father still had pain in the left leg that they took the veins from for his bypass surgery. When it failed to improve with time he had the doctor examine his leg closer. A Doppler test revealed for the first time what would prove to be my father's most serious health condition. He had an aneurysm behind the knee of the left leg. We were informed that it was very common for this condition to be in both legs. So they performed another catherization-like test where they shot die into Dad's lower body. It was discovered through this test that my father's entire lower vascular system was riddled with aneurysms varying in size. The most threatening one at the time of the test was the one in his left leg. While it was not life-threatening it was limb-threatening and the thought of losing his leg was enough to make dad go for another surgery not even 6 months after his open heart surgery.
Once again we summoned the talents of the well-known vascular surgeon Dr. George Todd at Columbia. This time the leg was fixed with a Dacron tube. One week was spent in the hospital before dad returned home this time.
Now aware of my father's tendency toward aneurysms Dr. Todd monitored him a bit more closely. At the next 6 month mark the aneurysms in the iliac arteries (lower stomach region) grew to dangerous proportions. It was time once again to go "under the knife" and 6 months after his second surgery dad went in for surgery number three.
This time the Dr. Todd picked up where the Dr. Edwards, the cardiac surgeon, left off and cut my dad from the bottom of his open heart incision down the center of his belly over and across his left groin area. While Dr. Todd was inside my dad fixing the aneurysms that the test revealed he discovered a "hidden" aneurysm behind my father's intestines that measured over 8 cm in width. This "hidden" aneurysm was more dangerous than the one's that they opened my dad to fix in the first place. Fortunately it did not rupture and it was repaired during this surgery. The scariest part of this was the test didn't even reveal that this aneurysm existed! Tired and weary dad began his recovery process again and returned home in about an week or so.
The next year and half my father made it though without any surgery. In June, 2001 a routine EKG revealed some concern. They sent my father for a stress echocardiogram. The test was inconclusive, but dad had no symptoms so the doctors let sleeping dogs lie.
In February, 2002 dad began to experience shortness of breath again. This time they suspected the leaking valve in his heart. A catherization confirmed their suspicions and dad needed another open-heart surgery to repair his mitral valve and also a bypass on the fourth artery which now had a blockage.
On February 25, 2002 dad went back to Columbia-Presbyterian to once again meet Dr. Edwards in the operating room. This being his fourth major surgery (his second open-heart) the risk was slightly higher but Dr. Edwards felt his chances were very good. The benefits outweighed the risks, my father could no longer function in the way he was accustomed as his breathing and endurance were severely compromised so he consented to another surgery.
This surgery went very well. About 4 hours in length like his first surgery. The valve was repaired and the bypass fixed. Recovery was hard as it always is especially for open-heart patients the second time around. But after 12 days my dad was released to finish his recovery at home.
This time he did not recover the way he did the first time. Every day he complained that this surgery was harder than the first one, even though he had a much easier time this time around regarding the actual surgical procedure. He was in constant pain in his chest area and in about 10 to 12 days the incision in his chest began to swell and turn red.
On March 25, 2002 my father was readmitted to Columbia-Presbyterian hospital for a sternal wound infection. The doctors determined that the best approach would be to re-open the incision and flush out the infection as it seemed to go down to the bone. So once again on March 26, 2002 dad faced surgery number five. This surgery was performed by a plastic surgeon. We were told it was minor and not high risk. But as my dad always says it's minor surgery when it's done on someone else, when it's done to me it's major surgery.
Remarkably my father came through this surgery very well. His treatment for this infection was to be IV antibiotics for about 4 to 6 weeks. After a 12 day stay in the hospital they transferred my dad to a sub-acute aftercare unit back in NJ to administer the IV for the rest of his treatment. He was discharged from Columbia on April 1, 2002.
Early in the morning on April 2, 2002 my father got up and went for a walk around the facility before he was due for IV treatment. Finally feeling on the mend my dad went outside and walked around the grounds on this warm and sunny spring morning.
When dad returned to the unit the nurse took one look at my father and asked him if he felt alright. She said his color was poor, his skin was gray and he looked "bad". Suddenly my father felt slightly nauseous and an extreme pain shot down under his rib cage down and around his back and eventually made his legs weaken, especially his left leg.
They rushed dad to St. Michael's hospital in Newark, NJ as Columbia was too far. His blood pressure was very, very low but his heart rate was good and he was conscious. The EMT administered morphine in the ambulance which helped my dad with the pain which he described as excruciating. St. Michael's performed a lower CT scan on my dad which revealed that nothing had gone wrong with any of his prior aneurysm graphs. The scan revealed what the doctors called an acute dissection in his lower aortic artery but they also told us he had had this condition forever and all seemed okay.
I never heard any of dad's other doctor's mention the word dissection and I was not comfortable with the diagnosis. But not being a doctor I figured that they must know better than I do. First mistake...always trust your instincts and never be afraid to ask questions.
My father's condition was puzzling to the doctors at St. Michael's as well as his doctors at Columbia as they now were aware of his condition. Back spasm? Kidney stone? No one knew. When my dad's condition seemed to be worsening as the day progressed we were more insistent that dad be transferred back to Columbia where he could be seen by the doctors who knew him and his lengthy history so well. It took a lot of patience but by 4:00 pm on April 3rd dad was back in Columbia-Presbyterian.
Once settled in dad's cardiologist, Dr. Livelli, decided to do another CT scan on my father. This time he wanted to check all the way up to dads neck to see exactly where the dissection began. St. Michael's CT scan stopped just below my dad's waist and didn't reveal what was to be discovered as the real culprit to this crazy day of pain and suffering.
Around 9:00 pm my dad was being taken down for the scan. My mom and sister had been waiting at Columbia since 12:30 pm. We were told that my dad's treatment would probably be blood pressure management and no surgery. So I sent my mom and sister home and said I would stay with dad for the test and then come home afterward.
The test was completed at about 9:30 pm. I was just getting my bags together and tucking my dad in for a good night's rest when the lights came on in the room and two cardio-thoracic residents burst into my dad's room and told him that the test revealed something very serious. An acute aortic dissection they called it. They said it went far up into the chest all the way into his heart and aortic valve. They said that he would need to go for emergency surgery that night. (By the way my father still had the staples in his chest from the surgery that just took place just a week prior to this occurrence.) Not to mention that he had just been through open-heart surgery one month prior. He was in a weakened state to begin with and the thought of yet another surgery was terrifying.
His options were few if any as Dr. Edwards explained the seriousness of his condition. We were told that if he didn't have the surgery he would not leave the hospital alive. If he consented to the surgery his chances were slim to none of surviving. It was like being hit in the stomach with a wrecking ball. I felt like I was in a dream, no a nightmare, that I couldn't wake up from. We were told the surgery would take anywhere from 12 to 16 hours and that all of the work of the previous surgeries may have to be redone (IE the four bypass graphs, valve repair, etc). It didn't look to promising for my dad.
Badly shaken from this horrible news I clung to my father and pleaded with him to hang on with whatever strength he had left inside of him. I could tell he thought he was going to die, and truthfully as much as I couldn't comprehend the thought of this world without him, I thought he was too weak and had been through too much to survive such a serious and long surgical procedure.
My family was called in to see and talk to my father before he was taken away for what we all feared would be the last time. I promised him that I would not let them begin the operation until he got to see everyone, and even though the doctors were anxious to begin the operation they bent to our wishes as they too realized the seriousness of the situation.
Heart-wrenching is all I can say about that night. April 4th 2002 12:30 am they wheeled my dad away. The last sentence I heard my father say was "It doesn't end here." What he meant by that I am not exactly sure. We were told to go home and come back in the morning as the surgery would go through the night and well into the afternoon of the next day. We all left except for my sister and brother-in-law. They "slept" on the cold waiting room floor all night long.
It wasn't until about 11:00 am the next morning that we had any news on how dad was doing. I accidentally bumped into one of the residents I had met during dad's last open heart surgery in February. He looked puzzled to see me in the hospital again. He hadn't heard yet what had happened to my father. Once I told him he went into the operating room to give my family an update on my father's procedure.
Remarkable! That was the word of the day. The worst day of our lives turned out to be the best day of our lives. By 11:00am my dad was off bypass. The dissection procedure was completed. They replaced his entire aortic artery that ran the full length of his torso from his heart down to his kidneys. The other bypass graphs held up and didn't need to be redone. He did need to have his aortic valve replaced as the dissection destroyed the valve. They used a tissue valve for the replacement. Another aneurysm was discovered in my dad's left groin and due to his vitals being so stable they called in a vascular surgeon to repair yet another aneurysm. He had made it through the surgery! We knew the road ahead would be a long one, but the first hurdle had been made. We all breathed a very cautious sigh of relief.
When I saw my father he looked no worse than he did for his prior open heart surgeries. But somehow I suspected this was the surgery to end all surgeries. The doctors called it World War 5. It was the pinnacle of my dad's surgical career.
The next step was would he wake up and if he did wake up would there be any neurological damage? Stroke, heart attack, and paralyzed from the waist down were the concerns. None of which, thank God, came to pass.
My dad not only woke up from this surgery but he was off the respirator in less than 12 hours afterward. It took him less time to get off the respirator this surgery than his other two times! He was in pain, excruciating pain but he was alive! The doctor in the ICU unit pegged him "Miracle Man". Never did they see anyone come through a surgery such as this so quickly. This made me happy and scared at the same time as anyone with experience with heart surgery knows it's the roller coaster ride of a lifetime. But he was strong, stronger than we all expected - stronger than he himself expected. He was out of ICU in 3 days (REMARKABLE!) and out of the hospital 2 weeks after this nightmare began.
Dad came home today, April 19, 2002. He is battle weary and exhausted but we are all so very glad to have him home and with us. He has shown me that there is strength within ourselves that we are completely unaware of. He has been a power of example for many of us. His courage and strength are beyond description.
When I learned more about the condition called "aortic dissection" and what it was I realize what a true "Miracle Man" he really is. This condition is rare and few survive the episode itself never mind the few that survive the surgery.
I don't know what attributed to dad's survival. The wonderful doctors at Columbia, the strength and will of my father's spirit to continue to be with the people he so dearly loves, the prayers of many loved ones and friends or the merciful hand of God Himself. Maybe everything...who knows? The road back is a slow and long one but this situation has taught me a powerful lesson. Difficult doesn't mean impossible and the power of love goes very deep.
May God bless anyone who has had to face such a devastating experience, and may they have the same good luck to survive and be given another chance at life that my dad was given.
Update: 19 Jun 2002
It's been a couple of months since I wrote my dad's narrative. I wish I could say that his story ended there and he and my mom went on to live happily ever after. Unfortunately recovery from such a serious condition isn't as simple as that.
Since his release from the hospital on April 9th he has returned 2 times. His last admission was 5 weeks ago and he is still there as I write this. What can I say? Well meaning people ask "How's your father?". I simply don't know how to answer that question anymore. It's a day by day experience and there are no definite answers.
The infection in his sternum is the trouble he faces at present. It required him to undergo yet one more opening of his chest on June 7th. We are hopeful that they cut out the diseased tissue and bone and he can move along his journey to recovery.
We were told a few weeks after his dissection surgery that another aneurysm in his right femoral artery is rapidly growing and would need to be surgically repaired. This surgery was suppose to happen four weeks after the dissection surgery but could not and has not happened as the doctors could not risk the spreading of the infection.
We are hoping once the infection clears and his strength returns they can repair his other aneurysm and he can finally come home for good.
Fortunately my father has a strong will and spirit to live. Even with everything he's been through he hasn't lost his sense of humor. He has come to understand Tom Hank's character in the movie "Castaway" very well. Like Tom's character had his buddy "Wilson" the soccer ball. My dad has come to naming his IV pole "Baxter". It's a little added levity that helps my father make it through these tough times. I am headed over to see him today and spend some time with him.
Please keep him in your thoughts and prayers. I will be in touch.
Update: 1 Dec 2002
Hello everyone. I am pleased to let everyone know that dad's chest has finally healed. The drain came out just before his 71st Birthday. He looks wonderful and is gradually regaining his strength. He went back to the hospital yesterday to be evaluated on the right femoral aneurysm that is hopefully the last to be corrected. The size has not progressed since his last Doppler test in May (3.5 cm in girth; 5.2 in length) but definitely needs to be repaired. Dad is contemplating having the surgery after the holidays. We hope you all have a peaceful and happy holiday season and I will keep you posted on his progress.
Thank you all for your thoughts, prayers and caring emails they have been a source of continual comfort and support.