Random Thoughts, Part 1

Random thoughts and addendums: 

• We never made it to the Rock Hall. Delays. Changes in plans. We had planned to go on Sunday before my surgery, but changed our plans when we learned the Browns game would be letting out and Bruce Springsteen was performing a free concert in downtown Cleveland. Things were hopping in Cleveland this day, and we didn't want to have to deal with the throngs of people. 

• I arrived at the CC on November 4 for my surgery. Standard questions. Vitals. Gowned up. They even shaved my chest. Ready to go. Not yet. A doc and a nurse came in and told me that Dr. M had an emergency come up and that I was going to be bumped till Wed. They said there was a chance that I could get bumped, but I didn't think I'd get bumped TWO days. 

• Since I wasn't having surgery, we had a nice lunch at Claddagh (factoid: they do serve beer on election day in Ohio...not sure if they still prohibit it in Indiana or not).  

• The patient rooms at the CC has 42-inch flat screen TVs. But a lot of the effect was lost because the sound still came out of the crummy, bed-side, drive-in-movie-theater-like speaker. Man, I'm a whiner, don't you think?

• Lots of ways to improve efficiency, even at one of the best hospitals in the world. 

• We had to drive back from Cleveland because I had complications with my lungs. Note: make sure the rental company takes debit cards BEFORE you reserve a car. 

Addendum I

A couple things I forgot to mention from our meeting with Dr. M:

1) He said there's only a small chance (I think he said 10 to 15%) that I'll have to have my valve fixed again during my lifetime. 

2) He said there's a less than 1% chance that they'll get in there and have to replace my valve instead of repairing it. Therefore, he said I needed to choose what type of valve I would like: mechanical or biological. Mechanical would require that I take coumadin (blood thinner) the rest of my life, and be careful not to get too bruised (due to the blood thinner). He also said there would be a 2% chance, each year, of having some sort of issue that would require hospitalization of some sort. The biological (pig valve) is the preferred method these days because there is no need for blood thinner and the overall risk is less than the cumulative risk of the mechanical. Not that I'm going to need it, but I chose the biological. 

Delay of game

Well, I got a call from Dr. M's office last night and learned that my surgery will be bumped until Tuesday. Drat. He didn't get through all his patients/procedures on Friday, which pushes everything back a day. 

There's a chance it could even get moved back up, but we won't know until the last minute (the day before). Stay tuned. 

Meeting the surgeon...

It's been a pretty stressful week, as you can imagine, so we took advantage of our quiet, kid-free accommodations and slept in till late morning. The only thing on our schedule for the day was to meet Dr. Mihaljevic, my surgeon at 1:00. 

As I said in my earlier post, the hotel is very close to the hospital. We left our room around 12:50 and were on the fourth floor of the hospital at 12:55. We, of course, wanted to be on time because the surgeon's time is very limited and we didn't want to miss our chance. As it turns out, he got stuck in surgery and didn't end up seeing Dr. M until 3:00. You would think that the ladies at the desk would have told us that he was running late, but they didn't. Only when we asked did they mention it. Once we found that out, we were able to get a beeper and go down to the cafeteria to get something to eat. 

One of the things Juli and I have been noticing is the variety of types/colors of scrubs at the CC. As in most hospitals, the colors represent the occupation. We're making it a game (trying to pass the time) to guess what color went with what job. One of the reasons this is on Juli's mind is that she will soon be in nursing school and is "upset" that the scrubs the nursing students wear are "clown red". At the CC, we notice a lot of people wearing all white, which, to me, look like they were employed at some sort of mental asylum. Not that I've been to that many mental asylums, but it always seems to be the standard "funny farm" outfit in movies and cartoons alike. 

Bear with me, this IS going somewhere. 

While we we sitting in the cafeteria eating our lunch, I noticed a guy at the table across from me in an all-white outfit. For some reason, I noticed that we was wearing white dress shoes (not tennis shoes). I guess the fact that he was wearing white shoes (and black socks) kind of caught my attention, and I wondered to myself (not aloud) if this guy was an orderly, a nurse, or a janitor. Again, killing time does allows your brain to wander in goofy directions, but I noticed that even the people in the cafeteria had their own colored uniforms. I joked to Juli that they could really make themselves sound important by saying..."Yes, I work at the Cleveland Clinic...(under his breath) in the food court." 

After lunch, we head back upstairs and find out that it won't be too long until we see the surgeon. We get called back, wait in the room for a few minutes, and in walks the surgeon...the same white-shoe, black-sock-wearing man I saw in the cafeteria. I find out later that Juli had seen him walking in, in his all-white garb, and thought he might be a janitor or something. 

Sorry for all the preamble, but here's the important part relating to our meeting with the surgeon:

• Even though we had preconceived notions of this man as anything but a world-class surgeon who probably makes a million dollars per year, he blows us away with his knowledge, his demeanor, and his unassuming personality. He's from Croatia, has a slight accent, but has has an air (but not an arrogance) about him that is very soothing. 

• He said that, after the tests, that they confirmed that the leakage is severe, that I've had this condition for a long time and, as a result, my heart is enlarged. The fact that I'd stopped running for a few months would not have made my heart reduce in size because it's taken years for this to occur. 

• He says that the robotically assisted surgery is even better (with even smaller scars) than the traditional minimally invasive surgery. He also says that one of the great things about mitral valve repair surgery is that it's the only surgery that brings the patient back to his/her normal life expectancy. Other surgeries improve life expectancy, of course, but this one brings it back to normal. After all, the valve is fixed, therefore the heart is fixed. Cured. 

• Once my recovery is over, I can do ANYTHING a normal person can do. I wasn't sure if I was going to run again after the surgery (just to be safe), but there's no reason for me to worry. I think I'm going to register today or tomorrow for the Mini Marathon, which happens in May, but usually sells out in November. 

• Juli and I were talking about this before, so I asked Dr. M to describe how the heart/lung machine works. This may not be 100% medically accurate, but I'll do my best. They run a line in and out of my femoral artery and vein (in my thigh, near the femur). They then inflate a balloon in my aorta, which stops the blood from entering the heart (and the heart from pumping the blood). The heart/lung machine then circulates my own blood in and out, oxygenating in along the way. Then they stop the beating of the heart (kinda tough to operate on a moving object) by  injecting some potassium in/on the heart. Juli asked Dr. M how they keep the heart tissue from dying, and he says they "bathe" the heart in the nutrient-rich blood every ten minutes or so. It just blows my mind that this is even possible. In total, my heart with be shut off (asleep, according the the doc) for 60 to 80 minutes. Once the blood starts flowing, and the potassium wears off, the heart starts beating on its own. Sometimes, they have to give it a little jump start. Simply amazing. 

Testing, testing

Due to some sort of medical protocol or federal guidelines or some obscure and long-lost section of the Hippocratic Oath, the Cleveland Clinic needed to do all their own tests even though they already had all my records from Indy. 

The hospital is only two blocks from our hotel so at about 6:40am, we walked down Euclid Avenue in the dark (okay, there were street lights along the way) to the hospital. We get there, give them my name, and wait to get checked in. 

The hospital is an incredible building and, according to one conversation I overheard during the day, cost $1 billion dollars to build. That's along the lines of the new Lucas Oil Stadium and Convention Center or a new Casino in Vegas, but given all the high-tech equipment, I wouldn't be surprised one bit. Well, just did a quick search and found that it was more around $600 to $650 mill. Ish. But still. The place is impressive. While the renovated Community North in Indy is very nice, it's more like a great, big Starbucks. This place is more streamlined, high-tech and minimalist, which I'm sure is due in part to the fact that they get so many international patients. Just a guess. One of the coolest features is the "fountain" in the front of the hospital that is clear glass on the sides and has a blue hue due to, I think, colored glass. Looks like a big, blue Jell-o mold jiggling anytime the wind blows across it...watch it wiggle, see it jiggle. I can't seem to find a photo on the web, but here is the building itself with the reflecting pools in front.  

We were at the hospital from before 7am and didn't leave till around 5pm. Actually, the testing didn't take very long at all, but the waiting is what made our day so very long. A quick recap: 

Meeting Dr. Grimm (great name, huh?). Actually, Dr. Grimm was very positive. And nice. He walked us through through the procedure and answered a few questions. He's one of the cardiologists who sees patients before and after surgery. One of his partners will probably see me after surgery, but this Grimm fellow seemed pretty sharp. I told Juli that, mostly because of his hair, that he looked like he could play a TV doctor (I am a doctor, but I don't play one on TV). The best news was that he said that I might be able to avoid the Trans Esophageal Echo cardiogram. But he'd have to wait till he saw the results of my lab work and the regular echo. He also said that they'd be doing a TEE during my surgery (I'll be asleep) so that's another reason I might not need to have it beforehand. Fingers crossed. Toes, too. 

EKG/Chest X-Ray/Blood Test. It seemed like the completed all of these in less than 10 minutes, and it couldn't have been much longer than that. They have lots of techs working and they got me in and out and from room to room fairly quickly. 

Echo cardiogram. I've had several of these in Indy, and this one was similar for the most part...other than the fact that the tech was very friendly and chatty and we talked football (he's a Denver fan living in Browns town). The one thing they didn't differently here was, after the standard digging around with the goo-covered sensor on the left side of my ribcage, they placed the sensor at the bottom of my ribcage and just above my sternum below my neck. He said it gives them images of the aorta, and that it is standard protocol at the CC. He said a lot of places don't do it (including the several places I had been to), but it's good information to have. Dr. Grimm came in and looked at the results, and said he'd meet with me and Juli later. He did. And he said I didn't have to have the TEE. 

Cafeteria. You wouldn't think that going to the cafeteria would be a meaningful experience, but it actually was. After having lunch at the deli across the street from the hospital, we brought back a piece of carrot cake so we could eat it with Starbucks coffee instead of the often-questionable coffee-shop coffee. When we were sitting at the table, and older couple sat down next to us and starting chatting. Turns out, he was 91 and she was 92. He was cracking jokes left and right (funny jokes, not your typical old-guy, heard-them-a-thousand-times before jokes). One of the funniest things was that he kept joking how the lady next to him had food that looked so much better. He was eating, Talapia. Or, as he said, "an urbane way of saying catfish." He closed the top to his styrofoam box that contained the fish and said..."I'm going to go trade this in for a donut." I'm sure that line will come up again in my future conversations (at least with Juli) and I'll think of this very nice couple. They were there for a surgery their daughter was having. They had been married 70 years. In-credible. We offered to push the woman, who was in a wheelchair, back to the surgery floor. And they kept saying how nice we were to do that. I think (or I would hope) that anyone would have done the same for them. I never got their names, but said a prayer for them and their daugher. God bless them. 

Pre-operative clearance. Watched a horribly produced video that walked us through the day of the surgery. I knew most of it, but it was good to hear it all again, in chronological order, with visuals. Met a very upbeat nurse who, Juli observed, had hair the same color and length as our dog, Coco. She took a nasal swap to check for strep and, if I had it, would prescribe some nose gel to help fight it. But it wouldn't delay the surgery. Also gave me the pre-surgery rinse (to shower with) and some listerine to swish around the final two times I brush my teeth. They must have something against germs in their OR or something. 

Registration. Strangely enough, this was the last thing we did all day. And we waited. And waited for someone to call us back. After they finally did, we found out that I was already registered in their system (a guy had called me a couple of weeks back to get all the info). That's really the only gripe I have so far is the lack of connectivity between departments and between people. You'd think that a high-tech place like this would have their EMR (electronic medical records) so dialed in that their left hand would know what their right hand is doing. Apparently not. 

Dinner. Room service of a burger and some crab cakes. Very good. 

Kids. Juli and I both talked to all of them. Wesley needed some help with his science homework and I was able to assist telephonically. Gramma Holland was doing well. I got a phone call a little later from Sophia, in bed, who was crying because she missed us. I told her we missed her too and tried to make her feel better by looking ahead to the next few days...her fall party at school on Friday, Halloween, staying at Papa's house over the weekend, etc. I miss the kids a LOT, but of course need to keep things positive. It'll okay, honey, it'll only be a few days. We'll be home before you know it. (I can't believe I'm not going to see my kids for ten days!)  

We're here.

Arrived in Cleveland after a short, bumpy flight. Crazy trying to get everything tied up before we left town for 10 days, but we're here. Whew. 

The walk from the gate to the baggage claim had to be more than a half mile. We got our bags, and the prearranged shuttle/car driver was supposed to call us. He didn't. I called the hotel and they didn't seem to have any record of my car reservation. They sent another driver and he was there in about 30 minutes. 

The good news. When I talked to the lady at the hotel (the guesthouse), she said they were overbooked due to extended stays and that we would be upgraded to the "nicer" suites hotel. Owned by the same company. Also on the CC campus. The price was twice as much, and since we're going to be here for 10 days, it seemed prudent to stay at the guesthouse. I asked if they would be able to keep us in the nicer joint at our original price due to the inconvenience. The lady said I'd have to ask the front desk at the other hotel. Great. On the ride to the hotel, I was planning my argument and rationale to convince them to let us stay in the nicer hotel for the same rate. But when we got to the front desk, amazingly, they agreed without blinking an eye. Of course they'd let us stay. Outstanding. 

Let's hope the service at the hospital is this good. 

It's been eight days since my last confession...

Okay. Now that the surgery is scheduled for November 3rd, it's going to feel like a loooong four-week wait. I guess we'll work on getting work and bills and sundry other tasks taken care of before my hiatus from normal life kicks in. 

A few adds/updates since my last post (which many of you may have seen in an e-mail from Juli):

Dr. Who? Surgeon's name is Dr. Mihaljevic (click the link to check out his bio). This link here has some additional background info, plus some online Q&A between the doc and some patients. Note that the questions are from 2007. Very interesting stuff. Dr. M is one of the docs who brought this procedure to the CC. He is 44 years old. He hired and trained another surgeon and they now perform between 250 and 350 non-invasive procedures per year. 

Timing. We will be flying into Cleveland on Wed, October 29 and flying back to Indy on Saturday, November 8. 

Some good news. The CC said my leakage and enlarged heart are not as severe as the docs indicated here in Indy. But they still need to fix it. 

Pre-op. The pre-op appointment on October 30 will include blood tests, chest x-ray, echocardiogram, and a transesophageal echocardiogram (TEE) —you can probably guess by the name the route that's taken to capture the image. It gives the surgeon a much clearer (and posterior) look at the heart because the image isn't as obstructed by skin and muscles and organs and such. The TEE doesn't sound like much fun , but Juli said her Nana just had one during her recent stay at the hospital and they'll sedate me beforehand. Hey, it still beats the heck out of having my chest cracked open like a Thanksgiving turkey. 

Smile. I'm supposed to see my dentist (Dr. Jack!) before we go to Cleveland to make sure I don't have any oral infections. Appointment is October 20th. 

Operation notes. Just rec'd the package from the CC yesterday and it said that there will be three small incisions (I thought it was just one). Also, the surgery may be performed on or off pump (they may or may not stop and bypass my lungs and heart during surgery). I need to call and find out which one they'll be doing. 

Important events while we are in Cleveland: 

• Halloween. I'm sad that we'll miss seeing the kids on Halloween. It will be strange, but it makes more sense for us to stay in Cleveland. They'll have fun and get all sugared up with or without us. I'll just make sure grandma (or whoever's watching them that night) takes lots of pictures. 

• Election day. I've already printed out the absentee ballot form online. Juli and I will each fill one out. They will send us a ballot and we will vote by mail. Not as inspiring or fulfilling as walking into the polls on election day and casting your vote, but it will have to do. Hmmm, who will it be??? The "maverick" or the "messiah"????

• Colts versus Patriots, which kicks off at 8:15 the night before my surgery. I will definitely stay up to watch the entire game. It doesn't really matter if I'm tired the day of surgery, right? As long as I don't oversleep (which I won't). 

That's it for now. Maybe not many posts for a couple of weeks because we're just waiting at this point. Thanks to all those reading (and praying).