November 6, 2018, my 55th birthday, was a day filled with hope and excitement. The night before, Monsignor Francisco Rios joined me, my family, and a few friends in a hospital room at Kaiser Santa Clara Medical Center. He led prayers for a successful open heart surgery the next morning. The 30 or so people that crowded the room sang Las Mañanitas, the traditional Mexican birthday song.
In the morning, the surgical team and cardiovascular ICU team sang happy birthday before wheeling the gurney into the operating room to implant a mechanical pump called a Left Ventricular Device (LVAD). The procedure is straightforward. A surgeon cuts an incision on the chest, saws through the chest bone, opens the ribcage, inserts the titanium device into the lower heart, wires the chest bone together, and closes the incision. The operation typically takes 4-6 hours barring any complications.
Kaiser Santa Clara Medical Center established the LVAD program in 2017. The hospital hired the surgeon who participated in creating the program at Stanford Hospital. While there, he successfully implanted 250 LVADs. After more than a year of planning and assembling a team, the surgeon performed the first procedure at Kaiser about month before my surgery. I would be the second patient at Santa Clara to undergo the procedure.
Doctors were concerned about the condition of my heart. For 8 years, the right side was compensating for the damaged left side. The transplant evaluation confirmed that the right ventricle that pumps blood into the lungs was getting weaker. This causes elevated pressure in the arteries that carries blood to the lungs. The condition called pulmonary hypertension could be fatal during and after surgery.
In the months prior to the operation, doctors prescribed medication to relieve the pressure caused by pulmonary hypertension. This strategy worked until the weeks before surgery. During this time, I increased my activity level in a sort of “nesting” way. I wanted to make sure that my personal and professional affairs were in order before undergoing a major procedure.
When I checked into the hospital on November 2nd to prepare for surgery, the lead LVAD doctor approved the use of intravenous Milirinone, a short-term drug that helps the heart beat stronger and decreases pressure in the arteries that pump blood into the lungs. With that stress relieved, Sandra and I spent the next 3 days learning about the LVAD and post-operation care. The plan included up to 2 weeks in the ICU and another couple of weeks in the cardiac unit of the hospital.
After the festive singing of Happy Birthday on the morning of the procedure, the surgeon led an entourage of doctors, physician assistants, nurses, and support staff into the operating room at 8:00 AM sharp. Sandra, the girls, and a waiting room filled with family and friends anxiously settled into what was sure to be a long morning and early afternoon.
Just before noon, a physician assistant came out to inform Sandra that everything was going well. The surgeon successfully implanted the LVAD and was preparing to begin the chest cavity closure process. The waiting room erupted in cheers and a round of hugs. With the nightmare of 2010 still lurking beneath the surface of everyone’s memory, relief and gratitude filled the space.
For the next couple of hours, there was a relaxed mood in the waiting room. After getting a quick bite to eat, family and friends settled down in anticipation of the surgeon confirming that the procedure was complete. The room grew tense and concerned as the hours began to tick by. Finally, the physician assistant emerged from the waiting room with additional news. This time the news wasn’t so good.
The physician assistant reported that complications delayed completing the procedure. The surgeon and his team were diligently working on resolving the issues that prevented them from finishing. Once an update was available, a report from the operating room would be forthcoming. Everyone sat in stunned silence with the ghosts of 2010 swirling around the room. Prayers and whispered voices replaced the animated chatter and joking from 3 hours earlier.
Later in the evening, the surgeon provided a briefing to Sandra and the girls. Although he looked concerned, he still showed the same confidence we became accustomed to. As feared, the right side of my heart reacted negatively to the procedure. This may have caused inflammation of the lungs. My lungs were too swollen to close the ribcage and complete the procedure. Also, the heart had grown so weak that any contact with the heart tissue caused it to bleed into the chest cavity.
The good news was that the LVAD was working. With that in mind, the surgeon’s strategy was to leave my chest cavity open until the right side of the heart pumped efficiently enough to decrease the swelling in the lungs. He also inserted 3 tubes into the chest cavity to drain the blood that was pooling around the heart and lungs from the internal bleeding. After answering a blizzard of questions from Sandra, the surgeon returned to the operating room.
When Sandra and the girls were allowed to see me in the ICU, they found me in a deep sleep from the sedative medication. I had a breathing tube inserted in my throat and 3 tubes draining blood into 3 canisters sitting on the floor next to the bed. The gap in my chest was held open by a clamp-like device. A skin-colored mesh dressing covered the 8 inch by 5 inch opening. Sandra and the girls could see blood flowing and my heart pumping through the sterile mesh.
For the next 4 days, I remained in this condition as the surgical team ushered me from the ICU into and out of the operating room. On the second day, my heartbeat raced to unsafe levels as it struggled to find a rhythm. Doctors administered many electrical shocks to pace my heart. During one of those incidents, I was in the hallway being transported to the operating room when family and friends heard a doctor shout, “clear!” My body convulsed from yet another shock.
Finally, on November 11th, the surgeon emerged from the operating room with a wide grin to announce to Sandra that the internal bleeding had stopped and my lungs were no longer swollen. The procedure to close the opening in my chest was successful. As Sandra listened to the surgeon, she could see and hear his team in the background near the operating room doors joyously clapping, hugging, and high-fiving each other.
The dedicated surgical team remained in the hospital throughout the 5-day ordeal. The surgeon who came to Kaiser Santa Clara Medical Center from Stanford to start a state-of-the-art LVAD program kept vigil outside of my ICU room the entire time. There was little doubt of his commitment and dedication. His determination literally saved my life.
Some people mentioned to Sandra that I must have some sort of strong and amazing will to live. That will had to come from deep in my soul, they reasoned. Nothing else could explain the vigorous fight I put up while heavily sedated and unconscious. At first glance, that reasoning makes sense. It’s one thing to be conscious with the ability to make the decisions to do what it takes to survive. It’s another when no conscious control exists.
That’s where faith comes in. Sandra and I relied on our unconditional faith in God to provide answers to my unconscious will to live. We went into the week with hope and the comfort of knowing that the outcome would be in God’s hands. As it turned out, another hopeless medical crisis ended in a miracle. I’m comforted that God will determine when it’s my time to leave this world. That week, my faith journey reached new heights.
With God’s grace, a talented surgical team, and a supportive community of family and friends, my life was extended yet again. At that moment, I was still in critical condition. The following days would surely be difficult, but hopeful. November 11th ended the same way the previous 5 days had. The waiting room gathered in a prayer circle to thank God .
Next Time: As I recovered from surgery and powerful sedative and pain drugs, I lived in a fantastical dreamlike world caused by ICU delirium.