Tuesday, May 22, 2018
One of America's Great Newspapers ~ Toledo, Ohio


Adversity brings meaning to life and love

THIS is my 401st column for The Blade. It would have been interesting to look back at the distance it has traversed and the controversies it has generated over the past 16 years. Instead, I would, with your indulgence, like to write about my recent heart surgery.

It was the little hill in Swan Creek Metropark in Toledo that did me in. Over a few months, I saw that molehill turn into a challenging mountain. Diseases are said to give their clues in casual parentheses. In this case, my anguished heart spoke in boldface.

The 16th-century English philosopher and artist Francis Bacon said that all our actions take their hue from the complexion of the heart, as landscapes take their variety from light. In the past 50 years, a relentless probe into the nature and function of the heart has led us to believe that instead of being the center of our soul and the seat of our deepest emotions, it is merely a four-chambered biological pump.

Its sole purpose, we are told, is to receive oxygen-poor blood, send it to the lungs, and then pump the oxygen-rich blood back to the body. I disagree.

To equate the human heart to a fuel pump in a John Deere tractor is to demean and reduce an exquisitely crafted organ. Dare we call Michelangelo's Pieta a carved chunk of marble, or Handel's Messiah a collection of disparate musical notes?

Surgery on the heart, compared to surgeries on other parts of the human body, is of recent vintage. In 1925, a daring English surgeon operated on a beating heart and opened a narrow valve by using his finger. In 1953, a new era of heart surgery was ushered in by the heart-lung machine, which allowed surgeons to work on a quiet, still heart while the patient's circulation was sustained by the machine.

All of us carry an ocean within our bodies. The 19th-century French physiologist Claude Bernard drew our attention to the ways in which organs communicate with each other across vast expanses of fluid. So intricate and well-balanced is the equilibrium that even a slight deviation in the acidity of the blood and body fluids is not compatible with life.

Whether this communication is through the network of nerves, hormones, cell mediators, or myriad other vehicles, we know but a small part of this elegant biological language. With the precision of a well-honed orchestra, the organs create the music we call life. The heart is an integral part of that landscape.

Despite our lack of precise knowledge of certain functions, surgeons are able to take a patient on a wild biological roller-coaster ride, wade through an altered physiological state, cross many Rubicons, then bring the patient back to life successfully.

In this landscape, there is an unknown and unmeasurable dimension described by Ambroise Par, the famous surgeon in Napoleon's army. "I dressed them [the wounds]," he said, "and God heals them." In my career as a thoracic and cardiovascular surgeon, I came to realize the wisdom of that adage.

For open-heart surgery, the preferred site of entry is through the breastbone. Homer, in the 8th century B.C., pointed out the exact location of the heart in describing the battle of Troy in the Iliad. A javelin penetrates the body where "midriff clasps the beating heart," to injure the organ.

In the modern version, the breastbone in sawn along its length, and the two halves are pulled apart to expose the beating heart. The patient's circulation is connected to a heart-lung machine.

The heart is put to sleep by cooling it with ice, cold saline, and, on occasion, the injection of potassium, not unlike the lethal injection used on death-row inmates. During a window of two to four hours, surgeons reroute the blood to coronary arteries. It was the only time my heart has rested in the 72 years it has been beating in my chest.

Once the intricate rerouting of blood vessels is accomplished, the heart is jolted back to life by electric shock. As the heart gains strength, the heart-lung machine is slowly turned down and then off.

I suffered a heart attack some 20 years ago. At the time, two superb cardiologists, Dr. Mark Burket and Dr. Nagi Bishara, got me through the initial setback. Ever since, Dr. Burket, a professor at the University of Toledo Medical Center, has kept me going with balloon dilations and stents. He assured me I could live a normal life.

A superb outdoorsman himself, Dr. Burket knew that normal in my case meant pursuing my passions for exploration, biking, squash, and a full professional and family life. In the years after the heart attack, I completed an exploration of the Indus River from Tibet to the Arabian Sea. But now, the little hill in Swan Creek Metropark had become more formidable than the 19,000-feet-high mountain passes I crossed with ease during my expeditions.

My surgery was performed by Dr. Tom Schwann, a competent and caring physician at the UT Medical Center. I can imagine the stress he felt operating on a colleague.

The day after surgery, while I was still on a ventilator, I saw him come into the intensive care unit to check on me. That was his sixth or seventh visit that day.

I smiled and asked for his hand. Unable to talk because of the breathing tube in my throat, I used my finger to write on his palm to tell him to go home. Not many people see that aspect of a surgeon's life.

Over the years, the UT Medical Center has consistently achieved results that place it among the leading centers in the country. It requires meticulous attention to detail and tenacity of purpose to reach the highest level of patient care.

After surgery, my few days' in the surgical intensive care unit was a unique experience. Under the influence of medications, reality and fantasy meshed seamlessly, while the common human trait of paranoia lurked in the wings.

Repeated reassurances by my family, nurses, and doctors helped me see reality through the fog and haze that shrouded my mind in the confining world of the intensive-care unit. Six days after surgery, I was home.

On the bumpy road of life, we suffer many setbacks that range from minor annoyances to life-threatening and life-altering catastrophes. It is usually in adversity that we realize the true meaning of life and love.

There comes a time, wrote author John Steinbeck, when each of us must ask: "Have I lived enough? Have I loved enough?" In my case, I have certainly lived well and lived enough. But most certainly I have not loved enough.

My next challenge, other than scaling the molehill in the park, is to travel freely on the highways and byways of life while keeping John Steinbeck's quote in mind.

Dr. S. Amjad Hussain is a retired Toledo surgeon whose column appears every other week in The Blade.

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